Permissions: You must have Billing Permissions.
Before you add Insurance to a Client's Profile, ensure your Client's Insurance company is in your database of Insurers. You can add multiple Insurers as needed and set one as Primary and one as Secondary. When adding Client's Insurance you will be able to add a Co-pay Amount, which will display on the Agenda and Invoice.
NOTE: We recommend keeping a copy of your Client's card on file in your Client's General Documents.
- Locate Client and open Client Profile.
- Click Bill To & Insurance Info tab.
- Scroll to Manage Insurance section.
- Click Add New Insurance button.
- Select Insurance Type, Primary or Secondary.
- Select Insurer.
- Using your Client's Insurance card, fill out as many fields as you are able.
- Be sure to add a Client Co-pay here if applicable.
- Click Save button.
If you need to add multiple Insurers, click the Add New Insurance button again and add new Insurer. Repeat steps above.
Insurance Detail field explanations and best practices. Listed in order from top to bottom of screen.
Effective Date - This is the Date the Client's Policy became effective. You can get this information when checking the Client's Benefits and Eligibility.
NOTE: This is a required field. The system uses the effective date to determine the correct payer(s) to resubmit claims.
- Insurer - Choose the Client's Insurance company from your database of Insurers.
- Insured ID - Enter the Client's ID number from their Insurance card. This is also commonly called the Policy Number.
- Plan Name - Not required, but will appear on your Client's Insurance card. If no name appears they don't have one.
- Policy or FECA Number - The FECA number is used in cases of Federal Worker's Compensation claims. Generally this box will be left blank. To satisfy Medicare requirements, type NONE.
- Group Number - Not all Clients will have a Group number, but if they do, it will appear on their card.
- Plan Subscriber Employer - Policy holder's employer.
- Co-Pay Amount - This will prompt the Client's Co-Pay to appear on the Agenda as well as on Invoices.
Contracted Rate with Insurer - This is your contracted rate with the Insurance company.
NOTE: This box is information only and will not automatically add a contractual to your Invoices.
- Deductible Amount - This is the field where you can enter your Client's deductible amount after verifying Insurance benefits.
- Remaining Deductible - Field does not automatically update but must be manually updated. Will show how much of the deductible is still left to be met.
- Out of Pocket Max - The most your Client will have to pay for covered services in a plan year. After they spend this amount on deductibles, copayments, and coinsurance, their health plan pays 100% of the cost of covered benefits.
- Deductible End Date - A calendar year deductible, which is what most health plans operate on, begins on January 1st and ends on December 31st. Calendar-Year deductibles reset every January 1. A Plan-Year deductible resets on the renewal date of your Client's plan.
- Co-Insurance Amount - Co-insurance is a percentage of the cost for a health service or prescription drug paid by a member after they have reached their deductible. This amount will show on the Agenda.
- Plan Subscriber Name - This is the name of the Policy holder. It is information only and does not transfer into the Claim. Please see the Insured ID section below for information on the Policy holder.
- Prior Authorization Number- If the Client's service requires an Authorization, you can enter in the authorization number given.
- Authorization End Date- This sets a Reauthorization reminder to be sent to the Therapist assigned to the Client. Enter End Date and you will receive notifications 7, 30, and 60 days out from expiration.
- Set Reauthorization Reminder (Sessions)- You can enter in the number of approved units. TheraNest will count down the number of Kept Appointments and notify you when the Authorization needs to be renewed.
- Accept Assignment - To Accept Assignment means you are accepting the Payers contract rate. If you are In-Network with the Insurance, you must mark Yes.
- Authorize Payment to Provider - This means you want the payment sent directly to you.
Client Authorized Release of Information Necessary to Process Claims - Choosing Yes means that the Client has authorized you to release any medical information necessary to process this Claim. This includes diagnosis, procedure, and notes if requested by Insurance.
IMPORTANT: This must be marked YES for Apex Claims to process.
- Client Condition Related to Accident - If your Client's condition is related to an auto accident or workman's comp.
- Insurance Information Verified by - This is a field where the Staff Member who verified the Insurance benefits is indicated. If this field is marked as Select One, either that option was not chosen, or the Client updated it via the Client Portal.