Insurance tab

You can manage insurance information for a patient on the Insurance tab of the Patient Information Center.

This tab will be empty if the patient does not have insurance; otherwise, you can select an insurance carrier in the list to view the information for that carrier. The number of insurance plans that are attached to the patient appears next to the name of the tab (for example, "Insurance (3)").

The Insurance tab consists of the following sections:

· Coverage section

· Patient Information section

· Subscriber/Employee Information section

· Policy Information section

· CDANet Settings section (Canada only)

· Profile Information section

· Eligibility Information section

Coverage section

In the Coverage section, a list of the insurance profiles covering the patient appears along with the employer and group number.

Patient Information section

The Patient Information section provides the following options:

· Birthdate - For your reference when calling the insurance carrier, the patient's birthdate and age appear.

· Subscriber ID - Type the insurance subscriber's identification number.

· Married - Select this check box if the patient is married.

· Handicapped - Select this check box if the patient is mentally or physically disabled.

· Relationship to Employee - Select the patient's relationship to the employee: Self, Spouse, Child, or Other.

· College/Address - Type the college and an address if the patient is a student.

· Sex - Select the patient's gender: M (Male) or F (female).

Subscriber/Employee Information section

The Subscriber/Employee Information section provides the following information for the person who subscribes to the insurance:

· Name - Type the first name, middle initial, and last name of the subscriber.

· DOB - Type the subscriber's date of birth.

· Sex - Select the subscriber's gender: M (Male) or F (female).

· Address - Type the street, city, state, and ZIP Code (the maximum lengths for each address field is 50 characters). You can also double-click the ZIP code field to highlight and paste in a ZIP Code; the city and state will be populated automatically.

· Soc. Sec. - Type the subscriber's Social Security number.

· Phone - Type the subscriber's telephone number.

Note: After you make changes to the subscriber's name, address, or ID, and then you leave the Insurance tab, you are presented with the option to synchronize the changes with all family members with the same insurance plan.

Policy Information section

The Policy Information section provides the following information for the person who subscribes to the insurance:

· Status - Select the status of the insurance policy: Primary, Secondary, Tertiary, Quaternary, or Terminated.

· Benefits Left - The benefits are reduced automatically as services are billed to insurance. However, if you know the exact amount of the benefits left for this patient in the current benefits year, you can enter the amount in a $$$,$$$.$$ format (up to the annual maximum) in the field provided.

· Deductible Left - The deductible is reduced automatically as services are billed to insurance. However, if you know the exact amount of the deductible left for this patient in the current benefits year, you can enter the amount in a $$$,$$$.$$ format (up to the annual deductible maximum) in the field provided.

· Effective Date - This date defaults to the date that the insurance was entered into the program but can be changed. Type the date the patient became eligible for coverage under the currently selected insurance coverage.

· End Coverage On - Type the date the currently viewed policy's coverage will end. The insurance policy will be terminated automatically in the program on this date.

CDANet Settings section (Canada only)

The CDANet Settings section provides the following options:

· Language - The patient's preferred language: English or French.

· Eligibility - The patient's eligibility status: Not-Applicable, Full-Time Student, Disabled, or Disabled Student.

· Card No - The patient's insurance card number. This field has a limit of 2 digits.

· Dependent Number - The number of dependents that the patient has.

· Payee - Who to pay: Pay the Subscriber, Pay other 3rd Party, Pay the Dentist, or Reserved.

Profile Information section

The Profile Information section provides the following information for the selected insurance profile, as contained in the Insurance Profiles window:

· Carrier - The name of the insurance carrier is displayed.

· Employer - The name of the employer for this insurance carrier is displayed.

· Group - Type the group number of the policy. Altering the group number in the Group field only changes the group number for the patient currently being viewed. To change the group number for everyone with the profile attached, edit the profile.

· Plan Type - The type of coverage is displayed.

· Status - The status of coverage is displayed.

· Benefits - The maximum annual benefits for the policy is displayed.

· Renews - The date on which the policy renews is displayed.

· Deductible - The maximum annual deductible for the policy is displayed.

· Estimate by - Select Percent UCR to calculate estimates by a percentage of the UCR fee, or select Estimator to calculate estimates using the Estimator.

· Contact - The contact person's phone number is displayed.

· Profile Comments - Any comments regarding the profile are displayed.

· Patient Comments - Any comments regarding the patient's insurance. If notes were entered for the patient's insurance during pre-registration or registration, those comments carry over to this field.

· Print Labels - Click this button to print an address envelope or label for the profile.

Eligibility Information section

The Eligibility Information section provides the following options:

· Eligibility Code - Type the code that some insurance carriers require to verify the a patient's coverage. The code can be updated automatically when you check the patient in through the In-Office Status for window. You can also set up the eligibility code in the insurance profile.

· Last verified on - Enter the date the patient's eligibility was last checked. The date can be updated automatically when checking the patient in through the In-Office Status for window.

· By - Type the name or initials of the person who confirmed the patient's eligibility. Also, the name can be updated automatically when checking the patient in through the In-Office Status for window.

· Next due on - The next date on which the patient's eligibility must be checked is displayed. The date can be updated automatically when checking the patient in through the In-Office Status for window. You can set up the frequency with which the date must be checked in the insurance profile.