Chapter 6: Insurance

In our 6th and final chapter, we’re diving into the wonderful world of insurance billing! Jane helps your clinic manage insurance policies and allows you to send invoices to 3rd-party payers.

In this guide, we will be reviewing the steps involved when billing to a 3rd-party outside of Jane, either via an external portal, insurer website or by paper. We will not be reviewing Jane’s direct integrations within this guide, but feel free to hop on down to the bottom of this page for additional resources. ⤵️

Managing insurance policies can work a bit differently depending on where you are located. We’ve divided this final chapter by location, so if you are one of our lovely US clinics, skip on down to the US Billing section to start learning. 🇺🇸

Note: The features covered in this chapter are only available to clinics on our Insurance Plan.

The 🇨🇦 Insurance Billing Workflow from Start to Finish

Let’s get started with a video that will walk us through an overview of the steps involved in billing to a 3rd-party. Within the next sections that follow, we’ll be walking through each of these steps together so that you can feel confident when billing to a 3rd Party.

💡Jane Tip: We recommend heading over to Jane’s Demo Clinic to practice as you learn (www.demo.janeapp.com). The username is Owner, and you can find the login password by heading to the Jane App Community Group on Facebook and clicking the ‘Featured’ tab. We update that every week. If you’re having any trouble, you can also request the password by email ([email protected]).

Starting with the Basics

Let’s cover the basics first to ensure we’re starting off on the right foot.

Within Jane, you’ll see the words “policy” and “claims” sprinkled in a few different areas. So, you may be wondering, ‘What is the difference between a Policy and a Claim?’. Let’s take a look:

Insurance Policy/Policy describes the thing a patient has purchased from an insurance company or any third-party coverage the patient has (i.e. provided by their employer, gov’t, etc.). An insurance policy can cover multiple purchases - or can have multiple claims.
A Claim refers to each time you submit something against an insurance policy - it’s the thing you submit to the patient’s insurance. If you add an insurance policy to a visit, you create a claim under that policy. A claim can only have/come from one insurance policy.

Before moving on, we have a quick 💡Jane Tip for you!

If you haven’t experienced working with two screens you might fall in love once you try it. Most computers have a second port you can just plug another monitor in. It’s glorious and every administrator’s dream.

🇨🇦 Step-by-Step Insurance Billing to a 3rd-Party

Great, let’s keep going. 🙂 Within this section, we’ll be covering the following steps:

Step 1. Setting up your insurers

Step 2. Creating a client insurance policy

Step 3a. Booking an insured visit and submitting a claim

Step 3b. Updating coverage amounts after submitting a claim [before collecting payment]

Step 4a. Marking a single claim as submitted [from the appointment]

Step 4b. Updating multiple claim statuses [from the Billing tab]

Step 5. Reconciling an insurance invoice once payments have been received by the 3rd Party

And if you’d like to head on down to our Additional Resources section, you can click here.

Step 1. Setting up your insurers

Jane helps you submit and manage insurance policies through one of Jane’s direct integrations, or externally: by paper or through an online portal. Within this guide, we’ll be covering the latter. Before diving in, there are a couple of things that first need to be set up in your Jane account.

🎬 The first step is setting up your insurers. This will need to be completed by a member of your team with Full Access.

Learn more here.

Please pay special attention to the Portal URL field. Entering in your 3rd Party’s Portal URL (if there is one) will save you some precious time when you go to submit your claim later on…

Great! Now that we have our list of insurers set up, let’s take a look at the most common insurance workflows for front-desk staff.

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Step 2. Creating a client insurance policy

You can create a new Insurance Policy for your clients from two main areas; The Patient’s Profile or from their Appointment panel within the schedule view. In the below video, we’ll take a look at adding a policy to a patient’s profile:

Feel free to hop over to the following guide to learn how to create a client’s policy directly from their appointment in the schedule: Creating a Patient Insurance Policy

Practice Drill 🏈

Let’s try out entering patient insurance information.

Instructions:

Ryan Anderson is ready for his appointment at the Demo Clinic. He is seeing the clinic for low back pain.
Ryan let you know he has insurance coverage available with Manulife and has handed you his Manulife card. The card has a Policy #37895 and ID#10.
Navigate over to Ryan’s profile and head into the Billing tab.
Next, click into the Insurance Policies tab.
Use the New Insurance Policy button in blue to save Ryan’s Manulife policy information.

Touchdown! 📣

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Step 3a. Booking an insured visit & submitting a claim

Once you’ve created and saved a patient policy, you can start insuring your patient’s visit(s). 🎬 Let’s watch this in action:

To add a claim to a patient’s visit, you can scroll down to the Insurance Info section and select the “Add Policy” button.

If this is your first time adding a claim to your patient’s visit, you’ll find the patient’s policy saved for you to select. If this isn’t your first time adding a claim to a patient’s visit, then Jane will provide you with a list of previous options so that you can easily copy one over from a previous visit.

One important thing to keep note of is the insurance coverage amount. In this example, I can see that Nathan is 80% covered by the insurer and that the insurer owes the clinic $48.00.

We need to let the insurer know that they owe us this outstanding amount. At the top of the appointment panel, we can click “Arrive” once our patient is in the clinic for Jane to generate our invoices.

If we take a peek at the Billing Info section, you’ll notice that **Jane has created **two invoices for us to manage now. One invoice is for Nathan to settle up his outstanding balance, and the other invoice is the outstanding balance owed by the 3rd Party.

At this point, the insurance claim will still be unsubmitted. You are able to click the blue insurer name at the top of the appointment panel to open the claim management screen.

What you’ll find in the claim management screen is all of the information you’ll need to submit your claim through the portal. From here, you can launch the portal using the shortcut button at the top of your screen. You’ll need to log in and submit your claim in order to get a live time answer of what the insurer will owe.

Once you know the amount the insurer will cover, it’s time to crosscheck! Let’s click the “X” in the top right-hand corner of the window to exit the claim management screen, and navigate back to the Insurance Info section in your appointment panel to confirm that the amount the insurer said they’d cover, and the amount Jane thinks they will pay is the same amount.

If they match, great! We can proceed with taking payment from our client.

If they don’t match, then let’s take a look at the following step below.👇

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Step 3b. Updating coverage amounts prior to collecting payment from our client

Let’s pretend that after submitting our claim through the portal, we found out that the insurer will not be covering the original amount we had reflected in Jane. For the purpose of this step, let’s use an example. Let’s assume we originally thought the insurer would cover $48.00, but instead they will be covering $31.00— less than the original amount we anticipated. This is a fairly common scenario, so let’s take some time to walk through this.

What we want to do from here is correct the coverage amount so that it is accurate. Let’s navigate over to the appointment panel, and scroll down to the Insurance Info section.

If the coverage amount is lower than what we originally anticipated, we’ll use the Max Amount field to enter the exact amount the insurer is covering for the visit. This will override the invoice and let Jane know that the insurer owes [80%], up to a maximum amount of $31.00.

If the insurer owes us more than what we originally anticipated, we can use the Eligible Amount field to override the total amount owed. Just remember to change the % coverage field to 100%.

In this example, I’m telling Jane that our insurer owes the clinic 100% of $60.00.

In both examples, Jane will automatically do the math for you and push the remaining amount to the client.

Practice Drill 🏈

Let’s try updating the coverage for an insurance invoice.

Instructions:

You’ve submitted your claim through the portal and realized that the insurance coverage is only $20.00.
Navigate over to Ryan’s appointment panel, and scroll down to the Insurance Info section.
If $20.00 is less than what you had originally anticipated that the insurer owes, enter $20.00 into the Maximum Amount field. Nice work!
Bonus ✨ For some extra practice, why not pretend that the insurer owes you more than what you had originally anticipated. Enter 100% in the % Coverage field and remove the maximum amount. Then, enter $200.00 in the Eligible Amount field. Jane will override your invoice to reflect the new amount owed by the 3rd Party.

Touchdown! 📣

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Step 4a. Marking a claim as submitted [within the appointment]

Once the invoice has been updated and is reflected accurately, we can tell Jane that the insurer’s invoice was submitted successfully through the portal (or by mail).

There are a couple of different areas in Jane to mark a claim as Submitted. The first area is directly within the appointment panel. You’ll find a drop-down arrow to the right of the claim, and once clicked, you’ll have the option to Mark as Submitted.

Marking as submitted just means that we’ve completed our part and that we’re now waiting for payment from the insurer.

Another popular area in Jane we typically see our clinics use when marking multiple claims as submitted is within the Billing tab in the top blue bar. This is a popular option for busy clinics that prefer to update claim statuses at the end of the day. Keep reading on as we get to this area in the next section. **🙂

Last but not least, we can collect payment from Nathan to pay his portion of his visit.

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Step 4b. Updating claim statuses [from the Billing tab]

As mentioned above, many of our clinics will use the Billing tab in the top blue bar to manage multiple claims at once within the Claims Submissions section.

To navigate to this area, select Billing > and scroll down to the Claim Submissions on the left.

Although we recommend submitting your claims at the time of the appointment to ensure you are collecting the accurate amount from your clients, some clinics may prefer to update the status of their claims all at once at the end of the day.

Let’s take a look at three of our important claim submission folders to the left to help keep things organized:

Unsubmitted folder: This folder contains all of your claims that have been added to an appointment, but have not yet been marked as submitted.
Submitted folder: This folder contains the claims that have been marked as submitted (i.e., you’ve submitted the claim through the portal or by mail) and are awaiting remittance/payment from your insurer.
Approved folder: This folder contains your claims that have been paid. Claims will automatically move to your approved folder from the submitted folder once a payment has been received. We’ll take a look at how to reconcile an outstanding insurer invoice in Step 5.

If you’d like to learn about the Draft folder vs. the Unsubmitted folder, you can visit this guide here.

🎬 Let’s take a quick peek at the folders we mentioned above in the below video:

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Step 5. Reconciling an insurance invoice once payments have been received by the 3rd Party

You’ve made it to Step 5! Great work, this is the final step. 💙

Within this step, we’re assuming that you’ve received payment from the 3rd party payer. So, what we’ll want to do next is record the payment in Jane so that Jane knows to move your submitted claims over to the Approved folder and mark them as paid.

Let’s take a look at this quick video to see how to do that. You can jump to [1:10] to skip the refresher intro. ⏭️

As with many areas of Jane, there are multiple ways to do things! Although we recommend recording payment under Billing > Insurer Invoices, you do have other options. If you’d like to learn more ways to apply a payment to an outstanding insurer invoice, click here.

Practice Drill 🏈

Let’s record a 3rd party payment received by Manulife.

Instructions:

You just got paid by Manulife! 💸
Let’s click into the Billing tab in the top blue bar, and scroll down to the Insurer Invoices section. Click on Manulife.
Click the New Payment button in the top right-hand corner.
Next, select a payment method from the drop-down menu, add reference # 001122, and enter $200.00 into the Amount $ field. Click Next.
Now that the payment is saved, select the blue Apply button to the invoices listed until the total amount has run out.
Bonus ✨ Use the search field to enter in a client name or invoice number if you’re looking to apply the 3rd Party payment to someone specifically.

Touchdown! 📣

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Additional Resources

If you’d like to read more about our Canadian Insurance workflows [billing to 3rd parties], you can browse our below guides:

Here’s a quick video on how to add a claim to an insured product:

If you’d like to learn more about Jane’s Direct Insurance Integrations, you can explore the following guides:

🇺🇸 USA Insurance Billing

With our new US insurance features, Jane allows you to create Superbills, generate EDI files for Office Ally claim submission, enter EOB’s, handle write-offs, and generate CMS-1500 forms. To submit and manage claims, there are a couple of things that first need to be set up in your Jane account.

Getting Started With US Insurance

Note: The set up of insurance will need to be completed by a member of your team with Full Access.

Let’s review the workflows that are most common for front-desk staff members:

Creating Patient Insurance Policies

When you’re ready to start saving your patients’ insurance information, we call this ‘creating patient policies’.

To create a patient policy, you can begin from two main areas; The Patient’s Profile or from their Appointment.

Learn the steps to creating a patient claim in the following guide:

Creating a Patient Claim

Practice Drill 🏈

Let’s try out entering patient insurance information.

Instructions:

Ryan Anderson is ready for his appointment at the Demo Clinic. He is seeing the clinic for low back pain.
Ryan let you know he has insurance coverage available with Manulife and has handed you his Manulife card. The card ID number is #3789579.
Navigate over to Ryan’s profile and head into the Billing tab.
Next, click on the Insurance Policies tab.
Use the New Insurance Policy button in blue to save Ryan’s Manulife policy information.

Touchdown! 📣

Adding Billing Codes & Booking an Insured Visit

Once you’ve created and saved a patient insurance policy, you can start insuring your patient’s visit(s). The following guide provides a great overview of our recommended workflow for adding billing codes and insurance policy to patient visits. There are also some pro tips (i.e. how to copy a previous visit’s insurance info) in this guide that will help you down the road:

Adding Billing Codes & Insuring a Patient Visit

Superbills

You can create a superbill in Jane for any patients who would like to submit the document for insurance reimbursement (so you don’t have to, phew!).

You can generate a superbill for any appointment (paid or unpaid) after you’ve added billing codes. As a reminder, you can add billing codes to the Insurance Info section of an appointment from the Schedule.

Once you have added all of your billing and diagnosis codes to your patient’s visit, you can either Print, Generate a PDF, or Email a superbill to your patient.

Learn more here: Creating Superbills

Insurance Account Set Up

To walk through the insurance setup process step-by-step, a great way to start is by watching the videos linked below:

Getting Started With US Insurance

All done? Nothing can stop you now! Time to celebrate in Chapter 7.

All of the content in this course “Front-Desk Training” is subject to our Terms of Use.