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 sections in the Insurance tab- Insurance and Authorizations.

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.

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.

To add new insurance for a patient, navigate to the Patient Profile. Click the blue plus sign in the top right and select New Insurance.

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

Under the Policy section, add the Payer Name. You can start typing to select an existing payer. Payers are added to NikoHealth by those with Management Permissions. For more information on how to add payers, see the article Payers.

If the selected Payer Name has available plans, you can add under the Plan Name. Available plans will appear in the dropdown.

Under this section, you can add more than one of these types of conditions. After entering the information, click Add. You can then repeat the process as needed, clicking Add after each condition.

If the payer you are adding is a Workers' Comp payer or auto insurance, make sure you complete the required information related to the patient's condition.

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.To manually verify insurance, click Verify Coverage when creating or editing insurance.

When you try to verify patient insurance, one of the following verification statuses will populate:

You can check prior dates of service to verify coverage benefits within the Patient Profile, under the Insurance tab. (Note: to use this feature, the patient must have Insurance already added to their Patient Profile).

To verify, open the person's NikoHealth 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.

With the date now populated, click the button for View Eligibility.

Under this section, you can view and manage Participation. In the top gray bar, select whether to use the in-network or out-of-network benefit information when calculating the patient's cost sharing on Orders.

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's insurance information will open.

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

In the patient's History, click Benefits to view detailed information. To navigate back to the current insurance, click Active in the top right.

To Edit information for an existing insurance, hover over the insurance and 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.

To Delete insurance, hover and click on the red trash can icon. Note: this cannot be undone.

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 secondary will follow, then the tertiary, etc.

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 add a new authorization, navigate to the Patient Profile. Click the blue plus sign at the top right of the page and select New Authorization.

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

At the bottom, you have two options for your authorization.

Click Create when finished.

To Edit or Delete authorizations for a person, navigate to the person's Patient Profile. Under the Insurance tab, click on Authorizations.

To Edit information for an existing authorization, navigate to the Patient Profilehover over the authorization and click the pencil icon to the right.

To Delete an authorization, hover over and click on the red trash can. Note: this cannot be undone.

To view past authorizations for a person, navigate to the person's Patient Profile. Under the Insurance tab, click on Authorizations. In the upper right hand corner, click the History button.

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