The List of Insurance Policies list all policies on record for the patient. The List is divided into three groups: 1) Active Policies, 2) Expired Policies and 3) Policies not yet Active. (Only the groups which have items are displayed)
How to Create a Patient Insurance Policy
IMPORTANT:
Before you can assign an Insurance policy to a Patient you must first create it in the Insurance Manager - Back Office - Insurance & Accounting Tab
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Select the Add New Insurance Policy (1) button on the top of the screen, an Insurance policy registration screen will appear. You must select a Insurance Policy (2) from the available list of available Insurance policies created in the Insurance Manager - Back Office - Insurance & Accounting Tab (see below). To activate (be able to use the insurance policy you must assign a Policy in effect from date(3) this permits Filopto to use this policy starting from this date. The expiry date expires and cancels the policy for use after the entered date, if left blank it never expires. Depending on the business rules of the insurance company you may require to enter additional information as shown in item (4). Item (4) for USA clients will display the CMS-1500 Patient Information fields (see below for more information.
Users can take a picture (scan) and store a copy of the front and back of a patient insurance card by loading the image(scan) of the card in the Card (5) tab.
The insurance policy must be assigned (6) a usage priority such as primary, secondary, etc. for Filopto to be able to use it when doing claims.
1) Select the policy you wish to attach to the Patient (Select Policy button (2)) the drop down will display a list of the insurance policies previously entered into the system for the various Insurance Companies. (Insurance Manager - Back Office - Insurance & Accounting Tab)
2) Enter an effective date (if required) to tell Filopto when to use this policy. If you place an effective date in the future, Filopto will store the policy information under the "Not Yet Active" section and only start using the policy once the effective date has arrived.
3) Complete the information which is relevant for completing the Patient claims. The Claim data screen displayed can be different depending on the Insurance company being used (Canada).
When entering a Patient Policy record, certain key information is required for proper claim billing. The tabs provide users with an easy way for completing the required information to submit a successful error free claim. Some of the information use to complete a claim are pulled from the patient file and from this section. Make certain that all pertinent information are properly entered.
Warning: USA CMS Patient Information must be completed before a claim can be properly generated. Refer to your Insurance provider claims requirement information kit on the proper items to complete in this section. Additional information is also available from the CMS Government web site.
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The Required Information Tab is subdivided into various tabs permitting the recording of the CMS-1500 information required for claim submission. The CMS 1500 form field numbers are listed for easy reference to the CMS 1500 submission guideline provided by the CMS organization and your Insurance provider.
You must complete the associated CMS-1500 form section for each insurance plan. The information entered is specific to an Insurance policy and will only be used for claims using this insurance policy. At invoice time, this CMS-1500 information is automatically entered in the CMS-1500 form for automatic billing to the selected insurance plan.
Note: Carefully review each line of the CMS-1500 form and complete the identified fields as required. If no information is entered in this section, the invoice will not be able to generate a CMS-1500 form. Reviewed for accuracy.
Explanation of the content of each CMS-1500 field is available on the back of the CMS-1500 form or via the HIPAA web site (www.HIPAA.org or at http://www.cms.gov/hipaa/)
How to Assign a Patient Insurance Policy
Once an Insurance Policy is created for the Patient the policy can assign the Policy as either the Primary, Secondary, Tertiary, Fourth or as the default Auto/Accident policy. If the policy is assigned Filopto will automatically use that policy in the Claim creation process. If no policy is assigned as primary for example, then the user will need to select on each time an invoice is created. The user can also change the default Policy used at invoice time, prior to creating a claim.
On the List of Insurance Policy grid select the Assigned As drop down field and select the default value. Only one active policy can assigned at a time, therefore if you already have a policy which is Primary and select another one to become Primary the Assignment of the other policy is automatically removed.
If you have acquired the Alert Module for your Filopto installation you may see the following alert. If an insurance policy exist but none are assigned as the primary insurance policy, Filopto will warn you to assign a primary policy for the patient so that your claims can be process with minimal intervention from the users.
How to Edit a Patient Insurance Policy
To edit an existing Policy select the policy in the grid and click on the Edit button.
How to Remove/Expire a Patient Insurance Policy
If you have a blank or a patient policy you wish to expire (remove from active list of patient insurance policy), select the policy you wish to expire and open it.
Once the profile is opens you will need to have a insurance policy selected (1) insert a Expiry date for the policy(2). You will need to assign the insurance policy as either primary, secondary,etc so that Filopto knows when to use the policy when creating claims. Depending on the rules for the insurance policy you may need to enter additional information (4) ( since you are expiring the policy - not going to use the policy) you may enter any data to permit the expiry to be activated. Once the insurance policy expired it will be moved to the expired insurance policy list removing it from the active policy list for the patient.
