Welcome to our guide on the HCAI Block Billing workflow. If you’ve already been block billing in Jane and want a refresher on the steps, read on! However, if you’re new to billing HCAI in Jane, we’d recommend using our Third-Party Billing workflow instead. It’s a little faster and easier to pick up if you’re just starting out.
If you’re practicing in Ontario, you’ll be using HCAI’s portal to submit your MVA claims, and your OCF forms and invoices. In this guide we’ll go over our recommendations on how you can set up, keep track of and manage your MVA billing in Jane specifically for patients who are only covered under motor vehicle insurance.
For our recommendations on MVA billing for patients who have Extended Health Benefits coverage that needs to be billed in addition to their motor vehicle insurance, you can check out this guide.
Here’s what we’ll be covering:
- Setting up your insurers
- Creating custom billing codes
- Creating a claim and policy
- Insuring the appointment
- Billing a block
- Managing the insurer invoices
- Reconciling payment
- Managing the claim
- OCF forms
- Adding Extended Healthcare Benefits
Setting up your insurers
For a refresher on setting up insurers, you can check out this guide.
The only HCAI-specific tip to keep in mind is to make an insurer profile in Jane for each insurer you plan to bill. This helps keep everything organized when it comes to tracking your claims.
Creating custom billing codes
Once you have your insurer profiles created in Jane, the next step is creating custom billing codes. You’ll want to create a billing code for each billing block that you’ll be paid for by the insurer. Using billing codes in this way gives you the flexibility to bill these custom amounts using your regularly priced treatments. This helps keep your treatment list as short and easy to manage as possible.
Custom billing codes can be created by heading to Settings > Billing Codes > New Billing Code
In addition to creating billing codes for all the blocks, you’ll also want to create a “No charge” billing code that can be added to all visits that happen between the blocks.
That could look something like this:
Creating a claim and policy
Once you have the insurer and custom billing codes created, you’re ready to begin creating patient policies and claims.
From the appointment panel, under “Insurance Info”, choose Add Policy and then Add New Policy.
Choose the insurer from the list.
Next, you can fill in the policy details. The only required field is the Claim/Identification Number. In the middle section, you have the option to add the policy maximum, end date, and adjuster contact information.
You can also enter any Default Coverage Amounts that will automatically populate each time the claim is used. Setting defaults can help save time for subsequent appointments that are billed the same way each time.
Before, when we created our custom billing codes, you created billing codes with a cost attached and a no-charge code to use for appointments in between the billing blocks. We recommend entering the no-charge code into the Default Coverage Amounts area in the image below. This saves you some time because most of the visits you bill will be no charge, so you’ll only need to override this default billing code on the initial visit and the subsequent visits that you receive the block payment for.
Once you’ve finished entering the details, click the blue Save button at the bottom of the page.
For more tips on creating a policy click here.
Insuring the appointment
After saving the policy, you’ll see it’s already attached the claim to the appointment. You’ll find it in the Insurance Info section of the appointment panel.
Billing a Block
So, when we receive a lump sum payment from an insurer, we’ll want to apply it to an appointment. For the appointment to have the right cost, we’ll need to use one of our custom billing codes.
From the schedule, you can click on the appointment and scroll down the appointment panel on the right to the Insurance Information section.
You can either search for the billing code in the Add Billing Code field.
Or if there’s already a default billing code, you can click the down arrow next to it to change or remove it.
If everything looks good, you can Arrive the appointment to generate the invoices for the visit.
Managing the insurer invoices
MVA claims can be managed like any other claim submitted through a portal.
If you’ve added the link to the HCAI portal to the “Portal URL” field of your MVA insurer, then you can launch the portal from the Claim Screen. To do this, head to the schedule and click on the appointment to open the appointment panel to the right.
At the top of your page, below the patient’s name, there is the insurer’s name in blue.
When you click on the blue words you will launch the policy window including a “Launch Portal” button:
After submitting the claim, mark the invoice as submitted via the drop-down arrow next to its line item:
This updates its state from Unsubmitted to Submitted.
You can also manage claims from Billing > Unsubmitted.
In the Unsubmitted folder, click the drop-down arrow next to a line item to Mark as Submitted, and it’ll move to the Submitted folder.
Now you wait for payment.
Reconciling payment
When you receive confirmation from the insurer that payment has been received, you can record the payments in Jane using the New Payment workflow. If you’re unfamiliar with this workflow, please visit the guide document below.
Managing the Claim
Here are a few tips to make managing your MVA claims easier.
You can keep track of the end date on the main page of the policy.
In the Patient’s insurance policy area (Patient Profile > Billing > Insurance Policies), you can also do the following:
See the details of the claim to date, like amounts billed and paid, and visit counts:
Add notes or Tasks to create reminders regarding a specific claim/policy.
And view all of a given policy’s claims in one place:
OCF forms
The OCF forms are an essential part of your MVA claims.
You can find a list of downloadable PDF versions of OCF forms as well as information on filling out, submitting, storing, and tracking each OCF here.
The OCF forms cannot be filled out within Jane, but if you are working with fillable PDF forms that you have downloaded from the HCAI website and would like Jane to help give you a bit of a head start filling out some of the fields, check out our guide on Fillable Forms for more information.
Adding Extended Healthcare Benefits
One way to handle Extended Healthcare Benefits (EHB) is to bill them in one chunk, the same way we do block billing.
You would add the EHB policy to each visit as the primary policy, and then add the MVA claim to the visit as the secondary policy. For the MVA policy, you’ll want to add it to the appointment at no charge for tracking purposes until the last appointment in the block.
At the end of the block, once you know how much will be covered by the auto insurer (i.e. total block amount minus what the EHB covered), you can use the Eligible Amount field to enter the total amount the auto insurer will be paying for that block.
This is a good option for clinics where the patient will be seeing the same practitioner for the entire course of their treatment since there is no need to split the block payment between more than one person. This workflow is faster because you only need to add the MVA insurer total to a single visit rather than needing to go back and adjust multiple appointments.
You can always email us at [email protected] if you have any questions about any claims you’re trying to submit. We’re here to help!