Welcome back to the Jane US Insurance Billing training! If you haven’t already, complete the setup lessons first, starting with Insurance Setup 1: Adding Your Insurers.

This lesson is the first of nine in the US Insurance Billing training:

Billing Lesson	Status
Patient Insurance	✍️
Adding Billing Codes to a Visit	☐
Managing Insurance and Patient Responsibility on a Visit	☐
Claim Submission Folders	☐
Claim Submission	☐
Managing Rejections	☐
Posting Insurer Responses	☐
Resubmissions	☐
Accounts Receivable	☐

Now that your insurance features are set up, you’re ready to start submitting insurance claims. The billing workflow begins with entering patient insurance information, which you do by creating an insurance policy. Once you create a policy, you can attach it to any appointment covered by that insurer.

Instructions

Here’s how to create a patient insurance policy in Jane. You can start from the patient’s profile or from their appointment, and the steps for entering the insurance information are the same from there.

Starting from the Patient Profile

1. Go to the Patient’s Profile > Billing tab > Insurance Policies.
2. Click New Insurance Policy.

Starting from the Appointment on the Schedule

1. Click the patient’s appointment on the schedule.
2. In the Appointment panel, scroll down and click Insurance Info to open it.
3. Under Primary Policy, click Add.
4. Select Add New Policy.

Entering the Insured and Policy Details

📣 Heads up: The Subscriber / member identification number is the only field Jane requires.

1. Select the patient’s insurer from the list.
2. Enter the policy information in the fields described below.
3. Click Save.

If the insurer isn’t in the list, add it first. See our guide on Insurance Setup 1: Adding Your Insurers.

The sections below describe the fields on the policy form in the order they appear. Box numbers, such as Box 1a, refer to boxes on the CMS-1500 paper claim form.

Policy Details

• Name: Enter a name that helps you identify the policy. The name is for internal use only. Examples: Personal Injury Claim or Primary Insurer.
• Subscriber / member identification number (Box 1a): Enter the subscriber or member ID assigned by the insurer. Jane requires this field.
• Policy, group, or plan number (Box 11): Optional, but recommended if the insurance plan has an assigned policy, group, or plan number.
• Insurance plan name (Box 11c): Optional, but recommended if the insurance plan has a specific name.

Insured’s Information

• Patient relationship to insured (Box 6): Select the patient’s relationship to the policyholder (subscriber). Select Self if the patient is the policyholder. If you select another option, enter the subscriber’s demographics.

Policy Limits and Adjuster

• Policy maximum: The dollar amount that can be billed to the policy.
• Maximum number of treatments: The maximum number of treatments the policy covers. For example, if you enter 12, Jane counts the visits under this policy and notifies you once the 12th visit is booked and arrived.
• Current number of treatments: The number of treatments currently invoiced under the policy.
• Policy end date: The last date of coverage for the policy.
• Adjuster name, Adjuster phone, and Adjuster email: Contact information for the patient’s adjuster.

Authorizations and Signatures

• Patient release of information (Box 12): The patient signature that authorizes the release of medical information needed to process claims under this policy.
• Signature on file (Box 13): The insured’s authorization of payment to the provider of services.
• Accept assignment (Box 27): Whether you accept payment assignment under the terms of the insurer’s program.

Signature on file and Accept assignment are usually set the same way: both Yes or both No. If your Billing Settings defaults are already set to Yes, you don’t need to set these fields on individual patient insurance policies.

If you set the Signature on file default to Yes, obtain the patient’s signature before billing for their visits. For guidance on when and how to collect signatures, contact your regulatory body or college.

📣 Heads up: If you’re courtesy billing (you’re out of network and expect the insurer to reimburse the patient directly instead of paying you), select No for both Signature on file and Accept assignment. If either field is Yes, the EDI file defaults to Yes.

Condition Details

• Is the patient’s condition related to (Box 10a–10c): Select Employment? (Current or Previous), Auto Accident?, or Other Accident? to indicate an accident or work-related injury.
• Additional claim information (Box 19): Add additional claim information if the insurer requires it.
• Early and periodic screening, diagnostic and treatment (EPSDT) referral (Box 24h): Select an option to identify whether a specific service line relates to the Early and Periodic Screening, Diagnostic, and Treatment program or a state family planning plan.

Dates

• Date of current illness, injury, or pregnancy (Box 14): Enter the date, then select which date you’re reporting: Onset of Current Symptoms or Illness, Initial Treatment, or Last Menstrual Period (LMP).
• Another date related to the condition of the patient or treatment (Box 15): If the date isn’t related to the current illness, injury, or pregnancy, select the type of date and enter it.
• Dates patient unable to work in current occupation (Box 16): Enter the applicable date range in the Last Worked and Return to Work fields.
• Hospitalization dates related to current services (Box 18): Enter the applicable date range in the Hospitalization From and Hospitalization Until fields.

🩵 Jane Tip: If you’re a chiropractor billing Medicare, enter the Initial Treatment date for the date of current illness, injury, or pregnancy. If you’re unsure, check the insurer’s billing requirements to confirm which date they expect.

Referring Provider

• Name and ID numbers of who referred or ordered the service(s) or supply(ies) (Box 17): Add the referring, ordering, or supervising provider’s information.

🩵 Jane Tip: If you’re a physical therapist billing Medicare, add a Referring Provider. If you’re unsure, check the insurer’s billing requirements.

Default Coverage Amounts

• Billing code(s): Add any billing codes you want Jane to add automatically to appointments that use this policy. You can also attach modifiers and diagnosis codes to each billing code. For example, a patient who typically has 97140 and 97110 with a $25.00 copay responsibility each visit.

• Co Pay: Add any applicable copay amount. Jane adds the copay to each visit that uses this policy.
• Deductible: Add any applicable deductible amount. Jane deducts any invoiced amounts from the remaining deductible.
• Coinsurance: Add any applicable coinsurance percentage. Jane calculates the percentage from the Allowed Amount for each billing code.

What to Expect

After you click Save, Jane saves the policy under Insurance Policies in the patient’s Billing tab.

Important Notes

• A Signature on file or Accept assignment setting on a policy overrides your Billing Settings default when the two differ.

Adding Prior Authorizations

Once you’ve created the insurance policy in the patient’s account, you can add a prior authorization using the Add Prior Authorization button. For a deeper look, see our guide on Prior Authorizations.

Checking Patient Eligibility

You can check a patient’s eligibility in Jane. All US customers with insurance features can connect their Claim.MD account with Jane to run real-time eligibility checks. For more detail, see our guide on Eligibility Checks with Claim.MD.

Nice work! Next up, adding billing codes to a visit.

Related Guides

• Next lesson: Insurance Billing 2: Adding Billing Codes to a Visit
• Training hub: US Insurance Billing Training Hub