How to Add Insurance to a Patient’s file
In CoAction you can add in an Insurance policy where the Patient (self), Another Patient, a Non-Patient or Company is the policy holder.
If you would like to select a Fee Schedule when applying insurance to a patients file, you will need to make sure the payer is set up in Admin > Payers and your Fee Schedule has been created in Admin > Fee Schedules.
Please keep in mind: Fee Schedules are not required for billing. They are just extremely helpful if you are aware of an insurance payer’s allowed amounts and would like CA to do automatic write-offs for the difference between what you charge in the office (listed in Price List) and that payers allowed amounts (Listed in the Fee Schedule).
Before we get started:
*If you are creating a policy where the Patient is the policy holder (self), please go straight to Step 1.
*If you are needing to create a policy when Another Patient is the policy holder, make sure the policy holding patient has their insurance snapshot as (self), set up before adding the additional family members. Please skip to Step 1.
*If you are creating a policy where a Non- Patient is the policy holder, you will need to follow these steps before moving forward: Go to the Patient Rolodex, Select Non-Patient Button at the bottom Left and add in ALL Necessary info into the Non-Patient tab and then select Policies tab.
Select Payer the Non-Patient has a policy with and Select OK. If the Payer is not present, Select ADD Payer in the bottom right of the screen, above the Cancel button.
Add in All Necessary, Policy Info, for the Non-Patient. (Any area you are unsure of can be left blank and filled in when adding the policy to the patient). Once Completed, select SAVE
Policy will appear in the window when completed, now you can Select SAVE
*If you are creating a policy where a Company is the policy holder, you will need to follow these steps before moving forward: Go to the Patient Rolodex, Select New Company Button and in all necessary company info on the main page. Once finished click on policies tab.
Select Payer the Company has a policy with and Select OK.
If the Payer is not present, Select ADD Payer in the bottom right of the screen, enter information, save, select payer when added to the list and select OK.
Add in All Necessary, Policy Info, for the Company. (Any area you are unsure of can be left blank and filled in when adding the policy to the patient). Once Completed, select SAVE
The Policy will appear in the window when completed, now you can Select SAVE
ADDING IN THE POLICY
Go to the Patient Rolodex
Select Patient Name
Go to the patient's Insurance Tab and Select ADD/EDIT button
Create New Policy, Next
Select New Primary, Next
- Self, if the patient is policy holder. (Skip to step 4)
- Another Patient, if another patient is the policy holder.
- Non- Patient, if a person is the policy holder and not a patient in the office.
- Company, if a patient’s company is the policy holder.
*If you select Another Patient
Select the Patients name who holds the Policy, Next
Select the Policy attached to that patient and select Next
*If you selected Non-Patient
Select Non-Patient that was added to the system, Next
Select Policy, Next
*If you selected Company
Select Company added into CoAction, Next
Select Policy attached to the Company, Next
Step 4: Entering Policy Information
This area is designed to keep your Patients ledger as accurate as possible so, its best to be as detailed as you can be.
Let’s breakdown the areas further
You will need to enter the Patients Insurance ID into box 1a and Select Relationship to insured in box 6. Relationship options in the dropdown are: Self, Spouse, Child, Other and Leave blank.
If the Patient has a co-pay, you will enter that into “Patient flat co-pay amount”. CoAction by default will apply the co-pay towards a deductible, if you DO NOT want the co-pay applied to the deductible, you will have to select the box provided under the co-pay amount that states “Do not apply co-pay to deductible”.
Then you will enter the percentage that insurance covers in the “Insurance percentage of covered charges” location.
If you are just placing in a policy as a courtesy or the patient’s insurance policy does not cover services, you will uncheck the provided boxes for the patient to be 100% responsible for charges, in the patient’s ledger.
In my scenario, my patient has a 25.00 co-pay and then insurance covers 100% of the charges after the co-pay.
If you enter a co-pay amount into the provided location but, the insurance percentage is left at 0%, all responsibility after the co-pay amount will be placed on the patient as well.
If a patient does not have a copay and patient has an 80/20 policy. Place 80% into to insurance percentage area and the system will place 20% on patient and 80% as payer responsibility to pay, in the patient’s ledger.
In this area you can enter a Policy Reset Date, indicate if this policy is a Capitation plan, Enter Deductible amount, Enter the Yearly Visit/Dollar Max and how much has been used at the time the policy is being added to the patient's account.
- Policy Reset Date: The date everything resets, and the counter starts over. A new insurance snapshot will be created automatically on this date.
- Yearly Max Visit: This is the maximum number of visits allowed for services in your office, during the patient’s policy year.
- Number of visits used to date: This number tells the system how many visits have been used in another location so, CoAction knows where to start counting. Once they hit their Max visit amount, the system will place 100% of the responsibility on the patient to pay for services rendered until the policy reset date.
- Yearly Max Dollar amount: This is the maximum dollar amount allowed for services in your office, during the patient’s policy year.
- Dollar Amount used to date: This number tells the system how much money has been used in another location so, CoAction knows where to start counting. Once they hit their Max Dollar amount, the system will place 100% of the responsibility on the patient to pay for services rendered until the policy reset date.
- Deductible amount: This is where you tell the system how much the patients full deductible is.
- Deductible to be met: Of the patient’s deductible, how much is the patient still responsible to pay. When a patient owes an amount towards their deductible, CoAction will place 100% of the responsibility on the patient to pay. The system will also monitor EOBs received into the office and once the office receives payment on services rendered, the deductible count will be stopped and any NEW charges to a patient’s appointment, from that moment forward, will be allocated based on the policy limits, co-pays and insurance percentage placed into VitaLogics.
- This is a capitation plan: You will only check the box provided if this is a capitation plan. A Capitation plan is a plan where a payment arrangement for health care service providers such as physicians, physician assistants or nurse practitioners. It pays a physician or group of physicians a set amount for each enrolled person assigned to them per period, whether that person seeks care or not.
Please keep in mind: CoAction Does not communicate with any other software or insurance payer database. CoAction can only count info placed into CoAction. If the patient has sought treatment at another location, the counts may be slightly off.
This area allows you to connect a Fee Schedule to a Patient and Exhaust Benefits until the reset date, for your Primary policy only.
The Reset date is selected in the prior section.
Fee Schedules are created in Admin > Fee Schedules. If you are entering in a policy for a payer, where a fee schedule has been created, you can select that fee schedule in the drop-down provided.
If you choose to Exhaust benefits in an insurance policy, you are provided two options: You can make the patient 100% responsible for the Price List amount (amount you charge for a service in your office) or the Fee Schedule amount (allowed amounts set forth by the insurance payer) while the benefits are exhausted.
Once the restart date comes up, the policy will go back to the original settings.
In this area, you will be focusing on info placed into the HCFA CMS 1500 form.
- Hold HCFA: If you select the hold HCFA box, HCFAs will not generate for ANY charges within the patient's dates of service until removed. This box does not go off policy start date but, starts the moment the box is pressed.
- Box 13 authorization of Benefits: This box must be checked if the Insured or Responsible party authorizes payment for treatment described on the HCFA generated.
- Box 11 Insured’s Policy Group or FECA number: This is where you would place the Insured’s Group number or FECA number to be presented on a HCFA form.
- 11b Employer’s Name or School Name: This is where you would place the Employer’s name or school name to be presented on a HCFA form.
- 11c Insurance plan name or program name: This is where you would place the Insurance Plan name or program name to be presented on a HCFA form.
- 11d Is there another health benefit plan: This location you must select Yes, No or Leave Blank. Select Yes if there is another health benefit plan such as a Secondary or Tertiary. Select No if the patient has a Primary insurance policy only and select Leave Blank if you were instructed to do so.
- 27 Accept Assignment: Select this box if payment will be sent to the clinic. Do Not select if the patient is to receive reimbursement.
This location is used when there is another health benefit plan. It is separated by Primary, Secondary and Tertiary tabs. You will place the corresponding info onto the correct tab.
For Example: If a Patient has a Secondary, the Secondary’s information will be placed in the box 9s area under the Primary tab. This way the Secondary info is printed on the Primary’s HCFA and provides the Primary the information on who to forward claims to. Tertiary insurance would be placed under the Secondary tab and so forth.
- Box 9 Other Insured’s Name: (Policy holder name)
- 9a Other Insured’s Policy or Group Number:
- 9c Employer’s Name or School Name:
- 9d Insurance Plan Name or Program Name:
At the very bottom, there is a location for Adjuster information. This info is not placed on a HCFA. In the event you have an Adjusters information, it can be placed here for record and viewed in the patient's Insurance tab, Primary sub-tab.
Once finished making all selections, Select Next
*If your patient has a Secondary, you will select Create New Policy > New Secondary and follow the steps to enter the Secondaries info and repeat these steps if your patient has a Tertiary insurance Policy.
When you are finished entering your patient’s policy information and they do not have any other policies to enter, you will select finished, Next.
Add in the Start Date for the Policy.
Make sure it is BEFORE the first Date of Service the policy is covering, Next
Select OK to confirm the new policy entered
You are all set!!!
If your patient requires an authorization before they can use benefits, please click HERE for information on applying an authorization code.
Training Video Reference
Please keep in mind, this is an old training video and may not provide a full explanation but, is provided for a visual walk through.