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How to Set Up and Bill to a Third-Party Payer (CA)

A lot of companies and workplaces have arrangements in place where they pay for an appointment on a patient’s behalf. With this setup, a third party will reimburse the clinic for a patient’s visit.

Jane can track and manage this type of billing by adding multiple “insurers” to the claim.

Processes like this can be a bit tricky at first since there are a few steps but we’ll walk you through the process every step of the way:

It might be helpful to just do one step at a time and follow along in your Jane account or Using Jane’s Demo Clinic. Following the steps in order will make more sense than trying to just review this whole list in one go.

Let’s dive into the steps together…

Creating the “Insurer”

Anyone other than the patient paying for the appointment would be considered an “Insurer” in Jane.

Head over to the Settings tab, select Insurers in the left sidebar menu and then click on the blue New Insurer button.

When you’re creating the Insurer, make sure to select the Regular Insurance/3rd Party Payer/Lawyer option. You’ll be able to set the name of the new Insurer to what you would like to appear on the patient’s invoice.

For more detailed information, check out our guide doc on Creating and Setting Up Insurers that walks through the steps.

Creating the Policy

Before we can add the third-party payer to the patient’s invoice, we’ll need to create a policy. To do this, head over to the patient’s profile and then click on the Billing tab within their profile. From there, you’ll head over to the Insurance Policies

Click on the blue New Insurance Policy button to get started.

On the next window, make sure to select the third-party payer that you’ve created.

When it comes to the policy information itself, you can enter information that would make it helpful to quickly summarize what the policy is for.

Check out our Creating a Patient Policy for more detailed information on this step.

Adding the Third-Party Payer to the Visit

There are a couple of different ways to add a policy to a visit and you can check out our guide doc on Booking an Insured Visit that walks through the steps in detail.

For this walkthrough, we’ll be heading over to the Schedule, selecting the appointment and adding the policy to the visit from the Appointment panel.

Click on Add policy under the Insurance Info section and you’re all set!

Creating the Invoice

When you mark this appointment as Arrived Jane will generate an invoice both for the patient and the third-party payer. If the third-party payer is not covering the full amount for the visit, you can update either the Eligible Amount or Max Amount and Jane will adjust the amounts owed accordingly.

Once the invoice is created, you can download a copy of it to PDF or create a statement and send it externally of Jane. See our guide on Insurer Statements that walks through the different ways you can generate a statement.

Recording the Payment

You can receive the insurer payment from the Billing tab right under the insurer, or from the patient’s Billing tab within their profile.

Option #1: From the Insurer area

Head over to the Billing tab at the top of your Jane account and then scroll down and click on the third-party payer’s name to open up their “profile”.

Next, click on the blue New Payment button to the right

Select the payment method, confirm the amount paid, and then click Next:

Once the payment has been added you can search for individual invoices using keywords in the search bar, or you can click View All.

Option #2: From the Patient’s profile

The other option is under the Billing tab within the patient’s profile and then clicking on the dropdown arrow to the right of View.

From the list, you can select Record the Payment in Detail to be redirected to the same area as outlined in Option #1.

See our Receiving an Insurer Payment guide doc that goes over more options for how you can record these payments.

And you’re all set! If you have any additional questions, we’re here to help! Feel free to contact us and we’d be happy to help 💙

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