Insurance
This screen displays the insurance policies and claims for the current patient.
The buttons are as follows:
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Create a new Insurance Policy |
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Edit the policy or claim |
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Delete the selected policy or claim. |
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Make a new claim |
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Submit a claim to the insurer. Once submitted, the claim cannot be changed. |
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Pays a gap claim. |
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Cancels the selected claim. |
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Mark a claim as being settled by the insurer. |
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Mark a claim as being declined by the insurer. |
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Print the selected claim. |
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Email the selected claim. |
Gap Claim Payment
If a claim has its Gap Claim flag ticked, it is a gap claim.
When submitted to the insurer, the insurer will determine the benefit amount, and the customer can either pay the gap, or the full amount.
Gap claims can only be paid after the claim has been submitted to the insurer i.e., the the Claim Status must be Submitted or Accepted.
If the insurer hasn't yet determined a benefit amount for the claim, a Waiting for Claim Benefit window will be displayed. This will monitor the claim, until the insurer notifies of a benefit amount. When this occurs, the Gap Claim Status changes to Received.
It may take the insurer some time to determine the benefit amount. Clicking:
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prompts to pay the full claim amount. The insurer will reimburse the customer. This option is only available once the insurer has accepted the claim i.e. the Claim Status is Accepted. |
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stops monitoring the claim. To restart monitoring, click Pay Claim again. |
When a benefit amount has been determined, a Pay Claim window will be displayed. This shows the:
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the total being claimed |
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the amount the insurer has agreed to cover |
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the difference between the Claim Total and Agreed Benefit |
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the amount already paid |
If nothing has been paid, or the amount already paid is less than or equal to the gap, the customer can elect to pay either the gap or the full claim.
If the customer has paid more than the gap, the customer must pay the full claim.
Selecting:
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a payment window will be displayed to collect payment up to the gap amount. On completion, a Credit Adjustment will be created, for the Benefit Amount. |
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a payment window will be display to collect payment to the claim total. |
Once payment is made, the insurer will be notified. This enables them to reimburse the:
- practice, if a gap payment was made
- customer, if full payment was made
