Now that you’ve set up your insurance features, you can start submitting insurance claims. Woo-hoo!
If you have not done so already, please go through the US Insurance Set Up Steps first.
Let’s get started!
Patient Insurance Policy
The billing workflow begins by entering patient insurance information inside their profile. This is done by setting up a new Insurance Policy.
Once an Insurance Policy has been created, it can be attached to any appointment covered by that specific insurance payer.
Entering Patient Insurance
To create a patient insurance policy, you can begin from two main areas; The Patient’s Profile or from their Appointment.
Here’s a quick video reviewing the steps:
📣 Since filming the video below, some labels have now been updated! Instead of Claims, you’ll need to select Insurance Policies to create a patient insurance policy in the patients Profile.
From the Patient Profile
From the patient Profile, you can enter your patient’s insurance information by heading into the Billing tab and then clicking into Insurance Policies. Use the “New Insurance Policy” button to get started:
From the Appointment on the Schedule:
If you would like to enter a patient’s insurance information from the main schedule, follow the steps below:
- Click on the patient’s appointment on the Schedule
- In the Appointment window, scroll down and click to open the Insurance Info area
- Click on the “Add Policy” button, and then select “Add New Policy”
Regardless of which way you start, the process from here is the same to enter their insurance information.
First up, select the insurance payer for the patient:
If you need to create a new insurer see this guide on Adding Health Insurers.
Next, give the insurance policy a name – this is internal and should be useful in identifying the policy. Example: Personal Injury Claim or Shoulder Injury.
Continue to complete all relevant insurance fields in the form. This is the area Jane uses to pull information for generating a CMS-1500 form or for generating an EDI file for claim submission.
If you plan to create a CMS-1500 or EDI file for this patient, you will want to ensure you fill out as many of the fields as possible.
While you can always return to this area later to fill in more details, you will want to complete this area before you generate a CMS 1500 form or submit an insurance claim under this policy.
Here are a few of the Insurance Policy fields and the box line they match up with on the CMS-1500 form:
- Claim, or Identification Number (Required): Box 1a
- Policy Number: Box 11
- Insurance Plan Name: Box 11c
- Prior Authorization Number: Box 23
- Injury Date: Box 14
- Signature on File: Box 13
- Accept Assignment: Box 27
- Insured’s Info: Box 6, 7, & 9
- Is the patient’s condition related to: Box 10
- Date of Current Illness Injury, or Pregnancy: Box 14
- Enter Another date related to the patient’s condition or treatment: Box 15
- Dates Patient Unable to Work in Current Occupation: Box 16
- Hospitalization Dates Related to Current Services: Box 18
- Name and ID numbers of who referred or ordered the service(s) or supply(ies): Box 17
Policy End Date & Approved # of Treatments
Within a Patients Insurance Policy, you’ll see this area on the left-hand side where you can enter in a policy end date or the max number of treatments:
This area can be helpful as Jane will help you with the tracking.
Let’s say you enter 12 treatments in the “Max Treatments” line once you know they’re approved. Jane is going to count the number of visits billed under this insurance policy, and will give you a notification once you book and arrive on the 12th visit:
You can also “View” the insurance policy at any time from the Patient Profile > Billing > Insurance Policies > View to see how many visits the patient has used.
If a patient gets approved for more visits you can “Edit” the policy to jump in and update the number of visits left.
Accept Assignment & Signature on File
When filling out this new insurance policy for a patient, you’ll notice the Signature on File and Accept Assignment radio buttons.
These fields will be included on both CMS-1500 forms (box 13 & 27) and EDI files that you generate for submission.
These fields can be handled in each individual policy you create, or you can set up a clinic/insurer wide setting to default one or both of these fields to ‘Yes’ for all patient insurance policies where you haven’t selected ‘Yes’ or ‘No’.
You can find that clinic wide setting by heading into Settings > Billing Settings
If you were to check off either of these settings (let’s say both for this example), then each insurance policy on your account that doesn’t have a value inputted for these fields would default to ‘Yes’.
If you had a policy where you selected ‘No’ and have enabled the ‘Yes’ default, Jane will ignore the default and use the ‘No’ value on the CMS-1500s and EDIs that you generate.
Please Note: If you do choose to default your Signature on File to Yes, it’s important that you do obtain your patient’s signature before billing for their visits. For specific questions on the importance of when and how to obtain your patient’s signature, it’s best to contact your regulating body or college.
Interested in collecting your patient signatures using Jane’s intake form feature? If so, please have a look at the following guide document: Intake Form: Require Signature Setting
Default Policy Information
The bottom area of the patient insurance policy gives you the option to add in default insurance information.
You can add default billing codes, co-pays, etc. to a policy which will then automatically add those same billing codes and amounts to an appointment when you attach the insurance. This comes in handy if the patient sees you for the same treatment with the same or similar billing codes each time.
You will have the option to adjust any default information at the time of visit should you need to make any changes. Jane gives you the option to remove a billing code, change a billing code, or add any additional billing codes. You can also add or remove diagnosis codes at the time of the visit.
For example, let’s say this patient typically has 97140 and 97710 with a $25.00 Co-Pay responsibility each visit:
Using the “Add Billing Code..” search bar, start by searching for the first CPT, 97140. Once I’ve selected the CPT code, I can enter in any Diagnosis codes.
You’re not required to add default coverage amounts. If you prefer to enter the billing code information on each visit separately, just create the policy with no default coverage amounts.
Click “Save” to finish!
All insurance coverage will be saved under the “Insurance Policies” area for the patient:
Can I do eligibility checks to see coverage in Jane?
At this point in time, Jane isn’t able to perform eligibility checks in the US.
However, this is something that we’re working on and would love to offer as part of this integration with Claim.MD. Keep your eyes out for updates on this coming down the pipes 👀
In the meantime, you can perform eligibility checks in your Clearinghouse or by reaching out to the insurer directly!
📘 Continue learning the insurance billing workflow in Start Billing 2 - Adding CPT & Dx Codes.