Insurance

Complete

This screen displays the insurance policies and claims for the current patient.

The buttons are as follows:

New Policy Create a new Insurance Policy
Edit Edit the policy or claim
Delete

Delete the selected policy or claim.
Policies that have been claimed, or claims that have been submitted cannot be deleted.
Claim Make a new claim on the selected Inusrance Policy
Submit Submit a claim to the insurer. Once submitted, the claim cannot be changed.
Cancel Claim Cancels the selected claim.
Settle Claim Mark a claim as being settled by the insurer.
Decline Claim Mark a claim as being declined by the insurer.
Print Print or email the selected claim.

Create/Edit Insurance Claim

Complete

This is the screen used to create or edit an insurance claim for a patient.

The fields are as follows:

Claim Number the number assigned to the claim by the insurer.
For claims submitted online, this will be set on submission.
Date the date the when the claim was created
Completed Date the date the when the claim was settled, declined or cancelled
Policy the policy that the claim is for
Author the user that created the claim
Claim Handler the user responsible for handling the claim. If necessary, the insurer may contact the Claim Handler with queries about the claim.
Location the practice location where the claim is being made
Clinician the clinician responsible for the claim
Amount the total amount of the claim
Tax the total tax of the claim
Status the current status of the claim
Notes optional notes
   

Conditions

The Conditions tab lists the conditions being claimed.

The fields are as follows:

Claim Number the number assigned to the claim by the insurer.
For claims submitted online, this will be set on submission.
Treatment Start the date that treatment for the condition commenced
Treatment End the date that treatment for the condition ceased.
If the condition is ongoing, this represents the last date when treatment for the condition was given to the patient, within the practice.
Amount the total amount of charges being claimed for this condition
Tax the total tax on the charges being claimed
Status the status of the condition
Notes a synopsis of the the condition being claimed
Charges the charges being claimed for the condition

Conditions can be added using:

  • Add
 Adds a Condition that requires the user to fill in all of the fields manually
  • Add Visit
 Adds a Condition where the fields and the charges are filled in automatically from the selected Visit
  • Add Problem
 Adds a Condition where the fields and the charges are filled in automatically from the selected Problem
 

Attachments

The Attachments tab lists the attachments that will be submitted as part of the claim. These are a copy of the original documents, taken when the claim is submitted.
To see what documents will be attached, click the Generate Attachments button.

The following attachments will be automatically added:

  • Patient History - the full patient history up to the time of the claim
  • Customer Invoice - an invoice will be added for each invoice referenced by the claim

History

The History tab displays the patient history, and is provided to help construct the claim.
It does not represent the history that will be attached to the claim when it is submitted.

Create/Edit Insurance Policy

Complete

This is the screen used to create or edit an insurance policy for a patient.

The fields are as follows:

Policy Number the policy number assigned to the policy by the insurer
Start Date the date the policy starts on
End Date the date the policy ends on
Customer the customer the policy belongs to
Insurer the insurance provider
Author the user that created the policy