| Notes: | You are not able to bill a secondary insurance using a Telus insurance company. You will have to submit the secondary by mailing the forms in or have the patient submit them themselves. |
| You are able to turn on and off some of the insurance sections if they are or are not needed for your clinic under Settings>General>Patients>Insurance. | |
| First you will create the primary insurance record and then create the secondary insurance record in the Patients Profile under the Insurance tab. |
- Primary Insurance setup
- Secondary Insurance setup
- The Patient Look up
- How to create the primary insurance record
- How to create the secondary insurance record
- Billing the Primary and Secondary Insurance
1. Primary Insurance setup
Step 1.
Navigate to the Patient Profile.
There are several ways to access the Patient Profile.
a. From the Patient tab.
b. The Quick menu located at the top of the home page.
c. The Patient Look up
You can use the patient lookup and click the Patient Name Link then click the Insurance tab in the patient profile.
| Note: If you have the Insurance field showing you can click that link to get to the Patient Insurance tab. |
Or
If you have the Patient insurance field showing in the Patient Look up pane you can select it.
Step 2.
Navigate to the Patient Profile>Insurance tab.
Step 3.
Select New Insurance to create the Primary Insurance Record.
Step 4.
Enter the Policy Details based on the primary insurer.
Policy Details - Explanation of items located down the left side of the Policy Details Section.
| Custom Label | You can use for example if a patient has more than 1 WCB claim the label could be WCB Back, the next insurance you create the label would be WCB Neck to prompt you which one to use. |
| Biller | This is used for Provincial billing. |
| Insurance Company | Select the insurance from the drop down options. |
| Policy Holder DOB |
Enter the DOB of the "Policy Holder". |
| Policy # Etc. |
Policy #, Certificate #, ID#, Plan #, Claim #, Student# will be completed based on what is on the patient insurance card and if there are red asterisks indicating it is the mandatory field. |
| Dr. Note Required |
Select Yes or No. |
|
|
Explanation of items located down the right side of the Policy Details Section.
| Provider | Used for Provincial Billing |
| Payable To | Used for Telus insurance billing. |
| Relationship to Policy Holder | Select who is the owner of the policy. |
| Contract # Etc. | Contract #, Group #, Division/Section #, Acct/Div #, Firm #, Group Name. These fields are entered based on the what is on the patients insurance card. |
| Dr.'s Rx Required | Select yes or no. |
Step 5.
Claim Information
| Injury Date | Select the date of injury. | Incident type | Select from the drop down options. |
| Injury Area |
Select from the pre-entered Injury Areas found under Settings>Injuries & Diagnoses Injury Areas.
|
Injury Nature | Select from the pre-entered Injury Nature found under Settings>Injuries & Diagnoses Injury Areas. |
| Employer Name |
Enter the patient's employer name. |
Employer Address | Enter the Employer address. |
Step 6.
Adjusters - this section is generally used for Ontario Billing with HCAI and Claims.
You can start typing the Adjuster name in the field.
If you don't find it you can add an Adjuster Name and contact details within the Adjuster field by clicking the down arrow at the end of the row.
Select the +Add option and enter the new Adjuster information if they are not already in your system.
Step 7.
Contacts
You can also add Adjusters by navigating to Settings>Companies & Contacts section>Contacts.
Select New Contact.
Enter the details for the Adjuster. Select Apply Changes.
Step 9.
Adjusters
|
Adjuster 1 Adjuster 2 |
Start typing the name of the Adjuster. If you have already entered it into the system it will auto- populate or see instructions above on how to add an adjuster. When you enter the Adjuster name, the phone, email and fax will auto-populate.
|
Step 10.
Deductible
Enter the Amount of the deductible if there is one, the Amount Paid and select Yes or No if it has been Paid This Year.
Step 11.
Policy Rules