How to Set Up Per Detailed Category Coverage Insurance

  • Updated

Insurance coverage can vary widely. When referrals are required for certain coverage types or when coverage categories share combined maximums, the detailed coverage tracker helps automate and simplify tracking a patient’s remaining funding.

 

Note: TELUS insurers are not supported for this coverage type

 

What You Need

Before you begin, ensure you have:

  • The patient's insurance card or policy information
  • Any required policy numbers, member IDs, certificate numbers, or group numbers

 

Permissions

  • Your User Type must have access to the Insurance section in the Patient Profile 
    • If you don't see this, contact your clinic's administrator 
    • User Types can be updated by an Admin Level 2 

 

Adding Insurance to a Patient Profile 

  1. Open the patient's profile 
  2. Select Insurance 
  3. Click + New 

 

 

The Patients / Insurance window will open. 

 

 

  1. Complete the Policy Details section: 

     

    Payable To
    • Select who should receive payment
    • For most clinics, this will be Default (Provider Organization)
    Insurance Company 
    • Select the insurance company from the dropdown list
    Policy Holder
    • Enter the policy holder's name exactly as it appears on the insurance card
    • By default, the patient's name will auto-populate in this field
    Relationship to Policy Holder
    • Select the appropriate relationship 
    • If the relationship is anything other than Self, ensure the Policy Holder and Policy Holder DOB are entered correctly
    Policy Holder DOB 
    • Enter the Policy Holder's date of birth
    • By default, the patient's date of birth will auto-populate in this field
    Policy Information 
    • Enter all policy numbers exactly as they appear on the insurance card
    • Field names may vary by insurer, such as:
      • Policy #
      • Plan # 
      • Member ID
      • Certificate #
      • Contract # 
      • Group #
    Custom Label 

    Optional: 

    • This allows you to display a custom name for the insurance policy
    • If left blank, the insurance company name will be used

     

 

  1. Complete the Policy Rules section:
Coverage Type
  • Select Per Detailed Category 
Coverage Reset
  • Select which month the coverage resets or 
  • Select Do not Reset if there is no date

 

Calculation Order
  • Select from the options depending on the insurance calculation method
  • The most common order is Max, Deductible, Percent
Combined Coverages 
  • If any category is combined with another, select Configure to create combinations
Provincial Coverage Exhausted 
  • Leave this set to No unless provincial coverage applies to this insurance profile
Category Rules See below 

 

 

 

Unlimited

Select this check box if the category has no maximum per year. Proceed to complete the percentage and other details of coverage.

Not Covered
This function is optional but recommended to use for removing categories from displaying in insurance remaining in other areas of Juvonno.
Category
The category created in Products & Services settings
%
Enter the percentage the category is covered for.
Max $/Year
Enter the maximum amount covered per policy year.
Max Assessment
Enter the maximum amount covered for the initial claim for under this category.
Max SubsequentEnter the maximum amount covered for any claims submitted after the assessment under this category.
Used Elsewhere
If the patient has used an amount elsewhere within the current policy year, enter it here. This amount will reset to 0 once the coverage reset is reached.
Max Visits
If the category has a maximum number of visits per policy year, enter it here. Once the max is reached, the invoice will be made out to the patient.
Referral Required?
Select the check box if the category requires a doctor's referral.
Referral Expiry
If applicable, use the calendar to select the date of which the referral expires. The date will appear when checking coverage remaining in other parts of Juvonno (such as Appointment Booking or Checkout). When the expiry is within 10 days, the text will appear in red to visually assist the user in informing the patient.
Coverage Remaining
This amount will calculate based on the amounts entered in the row. Select Save on the window and re-open to view an update to the total.


Category_Rules.png

 

Combined Coverages 


Configure-Combinations.gif

 

Choose a category from the drop-down list, and select Add Category to include it in the Combination (on the right). Once you have added all applicable categories to the list, select Create New Combination. Choose OK to exit and find the combined categories included in the list of Category Rules.
 

How to Delete/Modify an Existing Combination

Up at the top of the combined configured combination window the combined coverages will appear.

 



Select Configure and choose Delete next to the combination you would like to remove.





 

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