Insurance Profiles in Patient Setup screen
Insurance Profiles allow multiple primary insurances according to each visit for a single patient. Typically, this is used for offices that have patients using workers comp/no fault and commercial insurances that are both primary depending on which condition they’re being seen for.
In Patient Setup screen, navigate to Insurance tab. This is where insurances can be added, edited and termed.
- Assign a profile to this insurance grouping
- Assign Guarantor
- Enter Payer information
- Assign default Insurance Profile
- The Company Setting associated with this can be edited so that a different Insurance Profile is defaulted when adding insurance to any patient. Insurance Profile Company Setting
- The Default Insurance Profile for individual patients can be changed by checking the box for the Insurance Profile needed for that patient despite the Company Setting.
- Appointment Types with a default Insurance Profile will overwrite a patient's Default Insurance Profile.
* Coverage numbers will remain in order of entry and can be changed. The order they are listed in the Insurance Profile will be the indicator of primary, secondary, tertiary, quaternary.
Real Use Case:
Using the screenshot above here are some real use case scenarios:
- Scenario 1: Patient is seen in the practice for a Worker’s Compensation injury where Worker’s Comp is Primary with commercial insurance secondary. (Patient Setup compared to Appointment)
- Scenario 2: This same patient needs to be seen for a non-injury visit where commercial insurance is primary and no other insurance will be billed. (Patient Setup compared to Appointment)
- Scenario 3: That same patient might also receive DME benefits where only a DME specific insurance covers as primary. On the appointment the DME profile would be selected with the appropriate insurances listed.
