Insurance coverages have become more complex over time, with all forms of variation. Whether the patient requires a referral for a specific type of coverage over another, or certain coverage categories have combined maximums, this detailed coverage tracker can be utilized to further automate and streamline the patient's remaining funding process.
| Notes | This Coverage Type does not currently support direct-to-Telus submissions. |
Overview
- Add an Insurance
- Enter in the Details
1. Policy Details
2. Deductible
3. Policy Rules
4. Per detailed Category Rules
5. Combined Coverages
6. Other
1. Add an Insurance
From the Patient Profile> Insurance tab, select +New Insurance.
2. Enter in the Details
1. Policy Details
The most commonly required fields are outlined below:
Click here for more about what each field represents.
Descriptor (Renamed to Custom Label)
This is best used when there is more than one insurance profile created for the patient, to help distinguish one from another when booking and billing appointments. This will replace the insurance label (i.e. Sunlife 885884) with a custom name (i.e. Primary EHB).
Insurance Company
Select from the drop-down menu the insurance company. If you cannot locate the company, you can add them in manually. Head to Settings > Third-Party Companies and select + New.
Policy Holder
This will default to the patient. If the Policy Holder is the spouse, parent or other, replace the name to exactly how it appears on the insurance card.
Policy Holder DOB
This will default to the patient's date of birth entered in the patient profile. Edit this field if the policy holder is other than the patient.
Relationship to Policy Holder
This will default to 'Self'. If otherwise, select from the drop-down menu. (i.e. Spouse)
Policy # & Certificate # / ID #
Depending on the insurance company, some identifier fields may not be applicable.
Typically the Policy, Certificate (also known as ID) is entered.
| Note | When setting up for an MVA Insurance, be sure to enter in the Claim #. |
2. Deductible
Click here for more about what each field represents.
Amount
Enter the deductible amount for the coverage term.
Amount Paid?
If the deductible has already been paid (partially or in full) enter the amount paid here.
Paid This Year?
Select Yes or No depending on if the deductible was Paid within the current coverage term.
3. Policy Rules [NEW]
Select the Coverage Type: Details Category Coverage.
Click here for more about what each field represents.
| Coverage Reset |
Select which month the coverage is reset. |
| Calculation Order |
Choose from the available drop-down options |
| Combined Coverage | If any category is combined with another, select Configure to create combinations. Learn more here. |
| Provincial Coverage Exhausted | Leave this set to No, unless Provincial Coverage Applies to this insurance profile. |
4. Per Detailed Category Rules [NEW]
Click here for more about what each field represents.
| 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 Subsequent | Enter 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. |
5. Combined Coverages [NEW]
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.
6. Other
Click here for more about what each field represents.
Default
Select Yes or No to set this as the default insurance selected when booking/billing appointments.
Status
Leave this field as Active (by default). When the insurance is no longer valid, set to Inactive.
| Notes | Feel free to enter any other notes that may not apply within the Policy Rules section. Use the +Timestamp action to apply the current date and time to the note. |