How to Add an Insurance to a Patient Profile

If you have not already set up your insurance settings, click here to review the guide.

Adding a New Insurance

Navigate to Patient Profile > Insurance > New Insurance.

Policy Details Section




Custom Label field

If you do not see this field in the Patient Insurance record popup you have to enable it by going to: Settings > General > System > Patients > Insurance Section > Custom Label field.

Examples of using this field:

(Non-Telus) Define if you have, for example: 1 client (husband and wife) with 2 insurance companies. You can enter a label such as Blue Cross Primary and Manitoba Blue Cross Secondary.  This will allow you to select the correct insurance company when booking the appointment and billing the primary and secondary companies correctly.

A patient may have 2 WCB claims.  Enter the name of each WCB claim to easily identify it when booking an appointment.

Biller field: 

Only applicable to BC Teleplan.

Insurance Company:

Select the insurance company from the drop-down options (these are insurers you previously set up).

Policy Holder DOB: When you select the Insurer as Self the patients DOB will auto-populate. Otherwise, enter the correct DOB for the policyholder.

Relationship to Policy Holder:  Select from the drop-down options.  When you select the Insurer as Self the patient's DOB will auto-populate. 

Policy #'s: Enter Policy Holder information, claim #'s, policy #'s etc. related to the information provided by the patient.

Provider: Only required for BC and Teleplan.

Adjustor Section

Enter Adjustor information if it applies. This information will populate to batch invoices.

Deductible Section

Enter the Deductible details. (Not required when direct billing to Telus)

Policy Rules:

Coverage Type: Default 

Note:  Telus: The default must be 100%.
This would have been set up Settings>General>System>Patients>Insurance Section>Default Coverage Percentage (as stated above) it will automatically appear in this field. 

You are able to enter a percentage and override the default (does not apply to Telus) The default must be set to 100%. 

For example, you entered 100% in the system default you can override this by entering 80%, 50% or whatever it is based on the patient insurance coverage.

Private Insurance: Set this to the perentage the patient is covered for.

Coverage Type - Per Category

Use this option for insurance companies that are not submitted directly through Telus.

These categories are based on those you set up under the Setting>Product & Services Categories.

Some insurance companies cover different percentages based on the modality for example 80% for Chiro, 50% for Massage etc.

If your clinic has multiple modalities, set the Policy Rules Coverage Type to "Per Category".  The menu will expand where you can further define each service and amount of coverage based on the category.

If the total amount of coverage paid for each type of service, example, Initial Assessment is different total maximum than a follow up you will set up 2 Product & Service Categories.  Example, Physio Initial Assessment and Physio Treatment.

1. Product & Service set up:

    a. Department is Service / Category would be Physio Initial Assessment.

    b. Department is Service / Category would be Physio Treatment.

2. Patient Insurance set up for these 2 examples based on a total of $500 maximum for the year:

    Go to Patient Profile>Insurance Tab>Policy Rules Section>Coverage type: Per Category.

    a. Physio Initial Assessment / % - 80% / Max. Year $75.00 / Max. Visit $75.00

        (Max per year and visit for this example would be the same because the patient would                   typically only be having 1 of this type of appointment.)

    b. Physio Follow Up / % - 80% / Max. Year $425.00 / Max Visit $50.00

       (The maximum per year at $500 - $75.00 for the initial assessment leaves $425.00 balance             for follow-ups.)

Coverage Type: Block Fee

Enter a start date, an end date* and total amount allowed.
These policy rules will be visible in the appointment booking popup.
The total Amount will count down as it's being used.

Coverage Type: Telus Health eClaims

Coverage Type: Telus Health eClaims - Category Coverage

You can use the Coverage Type option to manually set up the individual percentages covered by insurance.  However, the invoice will still be submitted through Telus at 100%.

Coverage Reset

Select when the patient's insurance expires or select No Expiry if applicable.

OTHER SECTION

Default: When you book an appointment on the schedule the insurance field will automatically populate this insurance company name if you select the Default to Yes.

Status: When this insurance is exhausted or is no longer active set it to Inactivate.

Notes: Add any notes pertaining to the patient. 

Example: A patient comes in in the middle of the year and their total yearly insurance coverage is $1,500.00 however they only have $500.00 left for the remainder of the year.  You can add a note in this section indicating these details so you know in the new coverage year their total coverage needs to be updated to $1,500.00.  Also add a Warning on the Patients General tab, Warning section to alert you to reset this field.

Notes:

- Third Parties must first be set up under Settings >Third Party Companies before you can select the third party company in the patient profile.

- Telus: If you will be submitting claims through Juvonno for Telus, there is some additional set up required please review the Integrations > Telus section in the Knowledge Base. 

- You cannot bill secondary insurance companies through Juvonno.  Have the Patient pay the secondary insurance portion or you can submit the claim to the insurance company directly.