Lesson 7: Insurance

Jane University: Practitioner Training

💡Jane Tip: We recommend heading over to Jane’s Demo Clinic to practice as you learn! If you’re a current Jane user, you can find the login information by clicking the Need Help? Button in your account. This password is updated every Monday.

If you haven’t signed up with Jane just yet, you can find the login password by heading to the Jane Community Group on Facebook and clicking the Featured tab. You can also request the password by emailing [email protected].

We always recommend using the demo clinic for testing and practice so that your own account stays nice and tidy. ✨

Lesson 7: Insurance & Billing to a 3rd-Party

In our 7th and final lesson, we’re diving into the wonderful world of insurance billing! Jane helps your clinic manage insurance claims and allows you to send invoices to 3rd-party payers.

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

Managing insurance claims 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 :)

Insurance & Billing to a 3rd-Party

Jane helps you submit and manage insurance policies by paper or through an online portal. To insure visits, there are a couple of things that first need to be set up in your Jane account. The video below will walk you through the full workflow of insurance billing, and shows how all the pieces come together once implemented at your clinic.

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

Please note that the “claims” tab and button within the billing section of the patient’s profile are now referred to as “Insurance Policies”.

You may be wondering, what is the difference between a Policy and a Claim?

1. 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.

2. 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.

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

Creating a Patient Insurance Policy

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

You can create a new Insurance Policy from two main areas; The Patient’s Profile or from their Appointment.

Learn how to add a new Insurance Policy in the following guide:

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! 📣

Booking an Insured Visit

Once you’ve created and saved a patient policy, you can start insuring your patient’s visit(s). The following guide provides a great overview of our recommended workflow for booking an insured visit:

Booking an Insured Visit

Managing the Insurer Invoice

We have many Jane users working with online portals to bill insurance companies directly for their client’s visits.

This might be Medavie Blue Cross, Pacific Blue Cross, Telus E-Claims (including WSIB), HCAI, etc.

If you are billing to the portal immediately, you are able to click the blue insurer name at the top of the appointment panel to open the Claim Management Screen:

From here you can launch the portal using the shortcut button and you can see all the info you would need to submit through the portal on a single screen. Hooray!

There are also some great tips in the following guides that will help with managing claim submissions:

Working with Claim Submissions (Online Insurer Portal)

Working with Paper Insurer Invoices

💡Jane Tip: 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.

USA - Insurance Billing & Cash Visits

With our integrated insurance features, we provide clinics with the tools needed to run an insurance-based practice. These include the ability to submit claims, view claim responses, manage rejections, and post remittances all in your account through our integration with Claim.MD.

If you’re using another Clearinghouse such as Office Ally, Trizetto or Availity: you can generate EDI files for submission, and upload ERAs into Jane for speedy remittance posting – but for the most integrated workflow, we recommend submitting through our Claim.MD integration.

To submit and manage claims, there are a couple of things that first need to be set up in your Jane account. We’ve put together a separate series of training guides titled US Insurance Billing Training to delve into the intricacies of how US Insurance works in Jane and the workflows you can use to stay on top of your claims.

US Insurance Account Set Up

To get started with the insurance set up process step-by-step, a great way to begin is by following the link below to our first entry into the Us Insurance Set Up:

US Insurance Set Up: Step 1

Cash-Based Visits: Generating Superbills

Cash-Based clinics, we have you sorted, too! 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 an appointment after you’ve added billing codes.

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.

Superbills with Packages

If you provide superbills for patients who submit their receipts to insurance and they are redeeming Packages, then we suggest creating Packages that are “pay as you go” so the patient is charged each visit. Packages set up with an upfront cost and $0 per appointment will result in a superbill receipt that shows the patient paid $0, this is because no money exchanged hands at the time of the appointment.

We put together a quick video to go over the setup requirements. As a quick summary, the package will be set up as a “pay-as-you-go” offer, but an initial upfront payment is collected and stored on the client’s file as a credit. This payment is then used to cover the discounted rate of all upcoming appointments.

Already Set Up?

If your account is already set up for receiving and submitting US Insurance that’s great! We can start entering our billing codes and patient policies into our appointments in just a couple of steps. Watch the video below for a quick overview of how to manage the CPT and ICD10 codes on your patient’s appointments in Jane.

To get a complete overview of the way US Insurance works in Jane you can head over to our Start Billing series to learn more:

Start Billing 1: Patient Insurance

All done? Nothing can stop you now! Time to celebrate in Lesson 8.

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