Occasionally, you may need to submit an claim to a patient's medical insurance in lieu of or in addition to submitting a dental insurance claim. Before you can submit a medical claim, you must assign medical insurance to your patient/insurance subscriber.
Note: To assign insurance to a patient, the insurance subscriber must be listed as a family member in the patient's Family File. If the subscriber is not a patient, set the status to Non-Patient in the subscriber's patient information.
To assign medical insurance to a subscriber
1. In the Family File, select the patient/subscriber.
The Family File window for the selected patient/subscriber appears.
2. Double-click the Insurance Information block.
The Insurance Information dialog box appears.
a. Click the Medical tab.
b. Click the Carrier search button.
The Select Primary Medical Insurance Plan dialog box appears.
c. Under Search By, select one of the following options:
· Carrier Name - Searches by the name of the insurance company.
· Employer - Lists all insurance plans that have been entered previously for the subscriber's employer.
· Group Plan - Searches by the name entered for the group plan.
· Group Number - Searches by the number assigned to the group plan.
· Local Number - Searches by the local number assigned to the plan.
· Address - Searches by the insurance plan address.
· Payor ID - Searches by the insurance plan's Payor ID number.
d. Select the appropriate medical insurance carrier from the list, and then click OK.
Note: If the carrier does not appear in the list, click New and add the insurance carrier.
3. In the Insurance Information dialog box, do the following:
· Subscriber ID #- Type an ID number that is unique to the subscriber.
Note: While you can use a subscriber's Social Security number as an ID number, you can assign any number you want.
· Release of Information - Select to print the words "Signature on File" on the subscriber's insurance claims and authorize the release of information.
· Assignment of Benefits - Select to authorize the carrier to make direct payments to the provider.
4. Under Relation to Subscriber, select one of the following:
· Self
· Spouse
· Child
· Other
5. To update the information associated with the insurance carrier and verify that the claim format is HCFANPI, click Insurance Data.
Note: Medical insurance claims must be formatted to HCFANPI standards.
The Primary Medical Insurance Plan Information dialog box appears.
6. To edit insurance claim information, click Insurance Claim Information.
The Insurance Claim Information dialog box appears.
Note: Using the Insurance Claim Information dialog box, you can set the default claim information for all insurance claims created for the selected patient. Any changes you make are saved and used when you print future insurance claims. For more information, click Changing medical claim information.