Make your insurance and billing processes easier by setting up your client's insurance details.
In this article, we'll guide you on how to:
Enable insurance billing for a client
When setting up insurance, it's important to enable it first for your clients. To do this:
Go to Clients.
Select a client.
Go to the Insurance tab.
Click Edit in the Claim Settings panel.
Change the Client Billing Method to Insurance.
You have an option to turn on consents required to process insurance claims.
Click Save.
Note: To disable the insurance, you can replicate the steps and set it to Self-pay. Future appointments will now be created as self-pay.
Add a new policy
Go to Clients.
Select a client.
Go to the Insurance tab.
Under the Insurance policies panel, click +New policy.
Enter the policy details:
Insurance Type: Indicate if the policy is the client's primary or secondary coverage.
Policy status:
Unverified: Use this to capture policy details that have not been checked.
Verified: Select this once the policy is confirmed with the payer and ready for use.
Archived
Policy holder: Identify who owns the insurance policy.
Client: The client is the policyholder.
Parent: A parent owns the policy; a related contact must be selected.
Spouse: A spouse owns the policy; a related contact must be selected.
Other: Another individual owns the policy; a related contact must be selected.
Enter the Group ID, Plan ID, and Member ID.
Enter the Policy Start and End Dates.
Specify the default co-pay or co-insurance amount:
Toggle between co-payment ($) or co-insurance (%).
Enter the deductible for reference.
Upload card images for future reference.
Click Create to save the new policy.
If this is the client's first policy, additional options will now be available.
Marking a client's insurance policy as verified
After creating the insurance policy, you can verify the details with the insurance company to ensure accuracy and confirm coverage.
To do this:
Go to Clients.
Select a client.
Go to the Insurance tab.
Locate the Unverified insurance policy.
Verify details with the insurance payer, including:
Policy details
Covered services
Co-pay amounts
Edit the policy and update the Policy status to Verified.
Adjust service coverage and co-payments
If you provide multiple services to your clients, and their insurance policy specifies different co-payments for each. You need to set up their coverage accordingly.
Sample scenario:
Practitioner Wendy provides several different services to John, and John's insurance policy specifies various copayments for these services. Wendy wants to set up John's coverage to reflect this.
John's initial evaluation is covered with a $50 co-pay.
John's regular therapy sessions are covered with a $20 co-pay. Limited to 20 per year.
A more specific diagnostic evaluation provided by Wendy is not covered.
In the scenario above, Wendy can:
Set the Initial Evaluation co-pay to $50.
Set the Therapy Session co-pay to $20.
Set the Diagnostic Evaluation to "Not covered'.
After 20 sessions, change the Therapy session to "Not covered."
The service coverage values can be set to control how copayments are automatically applied to billing items. To do this:
Go to Clients.
Select a client.
Go to the Insurance tab.
Select the policy.
Locate the Service Coverage list and find the appropriate service.
Set a co-payment for a specific service
Follow the steps to navigate service coverage.
Expand service details.
Enter the co-payment value.
Click Save.
Set a co-insurance value for a specific service
Aside from co-payment, you can also choose to set a co-insurance value instead. To do this:
Follow the steps to navigate service coverage.
Expand the service details.
Click the % icon to toggle the co-insurance.
Enter the co-insurance percentage.
Click Save.
Disable coverage for a specific service
To disable service coverage for a service, do this:
Follow the steps to navigate service coverage.
Expand the service details.
Change the service from Active coverage to Not covered.
Notes:
Covered services with no co-pay set will use the policy's default co-pay value. This is useful for practitioners who provide services with the same co-payment.
Co-insurance can be set by changing the co-payment value to a percentage.
Coverage and co-payments can be configured for each active policy.
Archive an insurance policy
You can archive the previous insurance policy to remove it from the insurance settings and service coverage.
To do this:
Go to Clients.
Select a client.
Go to the Insurance tab.
Locate the policy.
Hover over it and click the Archive icon.
The policy and its service coverage are now archived and will not be used for billing. It remains available for reference and can be restored by selecting the Archived tab.
Adjust policy order and type
Multiple policies can be rearranged in the order they would typically apply to covered services.
Reorder policies
To change the policy order:
Go to Clients.
Select a client.
Go to the Insurance tab.
In the Insurance policies panel, press Reorder.
Change the policy order using the arrows or drag and drop.
Press Save.
Note:
The top policy will now be used by default when applying to billing items. You may press Reset to reset the policy order.
Change the policy type (primary or secondary)
To change your client's policy type:
Go to Clients.
Select a client.
Go to the Insurance tab.
In the Insurance policies panel, find the policy you want to adjust.
Press the Edit icon
On mobile, this is located under the More actions icon.
On desktop, this is available in the hover toolbar.
Change the policy type to
Primary
Secondary
Tertiary
Other
Press Save.
You can now request an eligibility and benefits report through real-time eligibility checks to help you verify a client’s insurance coverage before submitting a claim. This feature is available directly within Carepatron and integrated with ClaimMD.
Our team will be able to answer any other questions you may have. Just reply via messenger through the Help channel in your workspace.