Permissions Required: Clinic Staff must have Administrator, Billing Manager, Clinical Director, Front Office, Operations Manager, PTA, Staff Therapist, or Therapy Student Permissions assigned in order to manage Case Info.
Other Case Info: Policies Tab
The policies tab contains all of the information related to all the various policies for the selected patient.
Policies Area
| Policy Grid | The policy grid shows all of the policies for a given case. The policy grid works in the same fashion as the schedule and allows you to see which policies were in effect at which time. |
| Policy Detail | Clicking a policy in the policy grid will populate the policy detail area with information related to that particular policy. |
The Policies Tab contains all of the information related to the cases insurance policies. This tab is divided into two halves, the Policy Grid and the Policy Detail.
The Policy Grid looks quite similar to the schedule and works in much the same fashion.
As a patient attends therapy, it often happens that their insurance will change. This is especially true for patients visiting around the beginning of the year. The policy grid allows for changing insurance pictures without losing the historical picture. In the case shown above the patient has three policies shown. From January of 2005 through the end of May 2005 the patient had Medicare as a primary and Aetna as a secondary. In June of 2005, this changed to AARP as the primary and Aetna as the secondary.
This system allows for as many changes to the insurance picture as are needed. Any visit before June of 2005 would be billed with the Medicare/Aetna information, and any visit after June 2005 would be billed with the AARP/Aetna information.
As often happens, a patient will fail to inform a clinic of their change in insurance until after a few visits have passed. If this is the case then the new information can be entered retroactively for those visits. The past visits can be rolled back to Bill Primary in the transaction dialog (see Chapter 12: Transactions), and the next time they are billed the visit will pick up the new information.
When a new case is created, the Policy Grid is empty.
A right-click will bring up the following menu:
Add Policy
| Add Policy | Allows you to enter a new policy. |
| Edit Policy | Allows you to edit an existing policy. |
| Clone Policy | Allows you to make an exact copy of the current policy but for a new date range. |
| Find Policy | Shows all policies applied to this patient. Helpful in finding policies with a one-day length, as they are difficult to locate in the grid. |
| Delete Policy | Deletes the currently-selected policy. Note: This should only be used for policies entered in error, not for policies that are changing. |
| Carrier Note | Brings up the note attached to the carrier in the Carriers table. |
| End Date | Ending date of the policy as it relates to the clinic. This is the date that the policy will end on the Policy Grid. |
If there is a selected policy in the grid when the menu opens, the Edit and Delete policy options will be enabled. Selecting Add Policy will bring up the carrier select dialog. After the carrier is selected, the Add Policy dialog will appear.
Cloning a policy is useful when policy information stays relatively constant, but you have a new Authorization number for another date range.
To clone a policy, select the policy in the Policy Grid, right-click and select Clone Policy from the menu. A new policy will be created with a start date immediately following the end date of the policy being cloned. There must be at least 30 days of open space after a policy in order to be able to clone a policy.
Add Policy
| Ordinal | Allows you to select the level for the policy you’re entering. |
| Insured | Options are Patient, Guarantor, or Other Insured and relate to who is listed on the insurance policy. |
| ID Type | These correspond to the ID Type choices in HCFA/CMS-1500 Box 1. |
| Insured ID | Corresponds to HCFA/CMS-1500 Box 1a |
| Group ID | Corresponds to HCFA/CMS-1500 Box 9a. |
| Group Name | Not used on the HCFA/CMS-1500 but may be asked for when speaking to a carrier. |
| MediGap ID | Used by Medicare. |
| Start Date | Starting date of the policy as it relates to the clinic. This is the date that the policy will start on the Policy Grid. It is not necessarily the date patient received this insurance, but rather when the policy was active within your clinic. |
| End Date | Ending date of the policy as it relates to the clinic. This is the date that the policy will end on the Policy Grid. |
| Champus | Branch, Grade and Status may be entered here. |
| Ins / Patient % | If the patient has a percentage plan (80/20 for example), the percentage amount that the insurance company pays is entered here. The patient portion is automatically calculated. This percentage is considered when displaying the Contract amount during Posting (see Contracts chapter). |
| Co-Pay | If the patient has a co-pay, the amount is entered here. This has no relationship to the patients Estimated Payment Schedule even though in some cases it may be the same number. The copay is considered when displaying the Contract amount during Posting (see Contracts chapter). |
| Deductible | Amount of any deductible. This number is purely for clerical purposes and does not factor into patient statements or billing. |
| Deductible Date | Date deductible begins (i.e., a calendar year policy has a deductible that begins January 1st of each year). This date is purely for clerical purposes and does not factor into patient statements or billing. |
| Authorized | Indicates that the patient has been authorized for treatment by the carrier. This must be checked before bills can be generated for this policy. |
| Authorization Code | This field is required by some carriers. Anything entered here will be shown in HCFA/CMS-1500 Box 23. |
| Invoice Type | The default invoice type (Paper/Electronic) for a carrier. It is sometimes necessary to change the invoice type for a single patient and not for every patient with that particular carrier. This field allows for the default to be overridden if necessary. |
| Primary CFI | The default Claim Filing Indicator for a carrier when sending a primary claim. It is sometimes necessary to change the value for a single patient and not for every patient with that particular carrier. This field allows for the default to be overridden if necessary. |
| Primary ITC | The default Insurance Type Code for a carrier, when sending a primary claim. It is sometimes necessary to change the value for a single patient and not for every patient with that particular carrier. This field allows for the default to be overridden if necessary. |
| Secondary CFI | The default Claim Filing Indicator for a carrier when sending a secondary claim. It is sometimes necessary to change the value for a single patient and not for every patient with that particular carrier. This field allows for the default to be overridden if necessary. |
| Secondary ITC | The default Insurance Type Code for a carrier, when sending a secondary claim. It is sometimes necessary to change the value for a single patient and not for every patient with that particular carrier. This field allows for the default to be overridden if necessary. |
| Charge Limit | Allows you to set a limit on the dollar amount for charges on this patient with respect to this policy period. You will be alerted when the patient nears this limit. |
| Visit Limit | Allows you to set a limit on the number of visits allowed for this policy period. You will be alerted when the patient nears this limit. |
| Change Carrier | This button allows you to change the carrier for this policy. |
After a policy has been added it will appear on the Policy Grid.
The Policy Grid places these policies on the grid based on the Start and End Date listed in the policy. These two fields do not necessarily pertain to when the patient became eligible on their insurance policy. These start and end date simply apply to when the insurance is valid in your clinic.
Clicking on one of the policies in the Policy Grid will load that policy information into the Policy Detail area at the bottom of the screen.