Select the insurance tab to get to the insurance screen in your patient’s file and then select the “+” symbol on the top right. 

Select “New Insurance” from the drop down. 

Enter in the required information with the asterisks. Under “Relationship to Patient”, selecting “self” will auto-populate the patient’s information, selecting anything else will require you to enter the policy holder’s details.  

If necessary, there is also an area you can enter notes in regards to the insurance.

This field is used to request a specific coverage benefit from the payer. The benefit type field will default to Health Benefit Plan Coverage. You can choose to select a different benefit type such as Durable Medical Equipment by typing or choosing your selection in the field. Please note that not all payers return specific coverage information for a selected benefit. If the requested benefit information is not available the payer should return back general health benefit plan coverage information.

Now that your patient's insurance has been entered, you'll be given the option to verify coverage electronically if the payer supports electronic insurance verification.

Click on the Verify Coverage, and the system will verify the requested benefits electronically.

Once the verification is complete, fields related to in-network and out of-network benefits that the system is able to identify will auto-populate in the benefit summary section. Any fields that are not auto-populated is a result of coverage information not being identifiable. You can edit the benefit information as necessary. Please note that you can review additional plan benefit coverage information under the general eligibility information section after you click save.

If you manually enter information that the system does not auto-populate such as coinsurance, deductible or out of pocket values, this information will not be overwritten when a new verification of benefits is performed.

For example if initially it pulled the deductible information but could not identify coinsurance, and you entered the coinsurance manually, the next time a verification is done the deductible will display current accumulations as received from the payer but the co-insurance will remain as you had entered it.

Policy Information and Participation Level

Once verification of coverage is completed, in the Benefit Summary section you will notice a field that displays available policy coverage information returned from the payer. You can click on the drop down to review available coverage types. The benefit summary information will load coverage information according to your selection.

In the participation field you can indicate if you will use the in-network or out-of-network benefits. This selection will be used for this patients cost sharing calculation.

If you toggle off the Auto Update, when an insurance verification is done it will not update the benefit summary values.

Once you are done, please remember to click Save on the lower right hand side.

Once saved you will be redirected to the view mode of the insurance information available.

Benefit Information

In the view mode of the benefit information you can review all available coverage information.

In the Benefit Summary, the benefit information is displayed. If a coverage amount is not displayed you can add this in the edit mode by clicking the pencil on the upper right hand side.

The Plan Pays reflects the estimated % that this plan may pay towards covered medical services. This is calculated by taking into consideration Deductible, Coinsurance and Out of Pocket amounts.

The Plan Pays will reflect 0% until the individual or family deductible has been met.

After the deductible has been met, the plan is estimated to pay its split of the Coinsurance. Once the out of pocket has been met, plan coverage may pay for 100% of covered medical expenses. This is not a guarantee of payment so please check with the payer for additional plan coverage guidelines.

General Eligibility Information

In this section you will information as returned from the payer. The information displayed may vary from payer to payer. In the detailed information dropdown you can toggle between available benefit coverage returned from the payer. The information will display according to your selection.

Plans may return benefit coverage for different services. You can review benefit information to determine which may be appropriate. As in the example below multiple coinsurance % are available.