The patient Insurance tab is where you can add insurance information, verify insurance information, and manage authorizations for patients.

To work with a patient’s insurance, click the Insurance tab in a patient profile.

There are two subtabs for Insurance, the Insurance tab and the Authorization tab. We will go over both in the sections below.

The Insurance subtab is where you can add a patient’s medical insurance. You can add one or more insurances for a patient that can then be managed and prioritized as needed. To manage patient insurance, click the Insurance button at the top of the Insurance tab.

We’ll go over everything you need to know below.

To add new insurance for a patient, click the blue plus sign in the top right.

In the dropdown, click New Insurance.

The New Insurance page will open. Any fields with an asterisk (*) are required in order to add the new insurance.

As you fill out the appropriate fields, be aware of the following:

You can choose to verify electronic benefit information. The information returned by the payer will be displayed below. If the coverage information can be identified the benefit summary values will auto-populate. If the benefit summary information does not populate you can review the coverage information and manually enter any applicable values.

You can manually verify insurance by clicking Verify Coverage when creating or editing insurance.

When you try to verify patient insurance, there are four possible results:

You can check prior dates of service to verify coverage benefits within the patient insurance tab. To use this feature, the patient must have insurance already added to their profile. First, open the patient profile and click the Insurance tab. Locate the applicable insurance plan and click the calendar icon to the right.

On the new page, click the Service Date field. Use the left and right arrows to select the desired month and choose the calendar date you want to check eligibility for.

Click View Eligibility.

Here you can select whether to use the in or out-of-network benefit information available when calculating the patient's cost sharing on orders. Make sure when filling out the Benefits Summary section to select whether the coverage is in or out of network in the dropdown. The auto-update will automatically update benefit information when an electronic insurance verification is done.

When you’re done click Save to add the new insurance.

You can view the benefits of a patient’s insurance by clicking Benefits to the right.

A summary of the patient insurance information will open.

To see a patient’s old or previous insurances, click History in the top right.

You can view detailed information by clicking Benefits just as you can with current insurance. To view active insurances again, click Active in the top right.

To edit information for an existing insurance, hover over the insurance and then click the pencil icon to the right.

You can also choose to view the insurance benefits and then use the pencil icon in the top right to make changes.

Note: If you need to change information about the insurance provider itself, such as their address or claim options, see the article Manage Insurance Providers.

When you’re done, click Save in the bottom right to keep your changes to the patient’s insurance.

You can add multiple insurances for a patient. By default, the first or top insurance will be the primary insurance, the second will be secondary or tertiary insurance, and so on.

You can adjust the order of the insurance by clicking Change Priority in the top right.

In the new window drag and drop the insurances into the correct order, top to bottom, and click Save.

To remove insurance, hover over and then click the trashcan icon. Use caution when deleting an insurance, this cannot be undone.

The Authorizations subtab is where you can add any applicable prior authorizations. You can add one or more authorizations for a patient that can then be managed. To manage patient authorizations, click the Authorizations button at the top of the Insurance tab.

We’ll go over everything you need to know below.

To add a new authorization, click the blue plus sign at the top right of the page.

In the dropdown select New Authorization.

The New Authorization window will open. Any field with an asterisk (*) is a required field. Enter the relevant information.

If you have a payer rule defined for an authorization requirement, Expired or Not Available authorization invoices will go on Hold. To automatically apply authorization to any existing invoices waiting on it, use the Update Invoices on Hold for Authorization Required checkbox. Any invoices that match the authorization criteria on hold will automatically move forward if this is selected.

Click Create when finished.

To edit an authorization, hover over the desired one and click the pencil icon.

The Edit Authorization window will open. Make your changes and then click Save.

To view old authorizations, click the History button in the top right.

A list of all previous authorizations and their details will be displayed. To get back to active authorizations, click Active in the top right.

To remove an authorization, hover over the desired one and click the trashcan icon. Use caution when deleting an authorization, this cannot be undone.