Adding a Client Insurance Policy
To Add a New Policy:
Go to the Client Insurance tab.
Click Add 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.
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.
Click Create to save the new policy.
If this is the client's first policy, additional options will now be available.
Verifying a Client Insurance Policy
After creating the insurance policy, you can verify the details with the insurance company to ensure accuracy and confirm coverage.
To Verify an Insurance Policy:
Open the Client 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 change the Policy Status to Verified.
Adjusting 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:
To Adjust a Client’s Coverage and Co-Payment Settings:
Navigate to the Client Insurance tab.
Locate the Service Coverage list and find the appropriate service.
To Set a Co-Payment for a Specific Service:
Expand the service details.
Enter the co-payment value.
To Set a Co-Insurance Value for a Specific Service:
Expand the service details.
Click the % icon to toggle the co-insurance.
Enter the co-insurance percentage.
To Disable Coverage for a Specific Service:
Expand the service details.
Toggle the service to Not Covered.
Notes:
Covered services without a specific co-pay set will default to the policy's standard co-pay amount.
Co-insurance can be configured by switching the co-payment to a percentage.
Coverage and co-payments can be adjusted per active policy.
Enabling Insurance Billing for a Client
You need to add the insurance policy and ensure the deductible is met before coverage begins. Once the deductible has been met, enable insurance billing for future appointments.
To Enable Insurance Billing:
Navigate to the Client Insurance tab.
Click Edit in the Claim Settings panel.
Change the Client Billing Method to Insurance.
Click Save.
New appointments will now automatically check active, verified policies for billing items.
To Disable Insurance Billing:
Navigate to the Client Insurance tab.
Click Edit in the Claim Settings panel.
Change the Client Billing Method to Self-Pay.
Click Save.
Future appointments will now be created as self-pay.
Archiving an Insurance Policy
Archive the previous insurance policy to remove it from the insurance settings and service coverage.
To Archive a Policy:
Open the Client 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.
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