Back to top Back to top

 

Recording Patient Insurance Information

This section describes how to record a patient’s insurance plan and insurance relationship information. Topics include:

Viewing Patient Insurance Information

  1. On the left side of the Demographics screen, click Insurance.
  2. If you want to display only active insurance plans, select Active Only at the top-left of the screen.
  3. Click a plan to view or edit the plan information.

    For information on editing plan information, go to Adding Non-VSP Insurance Information.

    If your office recently moved to Eyefinity Practice Management from another system, you may have some patients with incomplete insurance information due to differences between systems. These incomplete insurances cannot be used on orders or in the Scheduler.
    A red icon appears in the insurance list to indicate plans that are missing information. Click plans to see what information is missing and make corrections.
  4. To view the patient’s eligibilities, under Insurance, click the Eligibility/Authorization link on the left side of the screen.
    You can view eligibilities for active insurance plans only.

    Icons indicate the patient’s authorization status. Only eligibilities that have at least one valid authorization appear in the list. For information on adding or editing eligibilities, go to Adding Eligibilities and Authorizations for VSP Plans.

  5. To view or edit details for an existing eligibility, click the link in the Auth # column.
  6. For VSP Plans, you can edit only the eligibility notes.
  7. For plans other than VSP, you can edit all the eligibility information. For more information, go to Adding Eligibilities for Vision Plans Other Than VSP.
  8. To view the VSP Patient Record Report for a VSP authorization, click the VSP Patient Record Report icon.

    For more information on VSP authorizations, go to Adding Eligibilities and Authorizations for VSP Plans.

  9. To view the patient’s used or expired authorizations, click the History link.
  10. Click the History link again to hide the authorization history.

Adding VSP Insurance Information

  1. On the left side of the Demographics screen, click Insurance.
  2. Click + Check for VSP Insurance.

    A message appears, asking if the patient is the subscriber/member of record for VSP:

  3. If the patient is the subscriber/member:
    1. Click Yes.
    2. Enter the patient’s SSN or unique VSP Member ID, if necessary.

      The VSP Member ID is alphanumeric and can be up to 30 characters.

  4. If the patient is not the subscriber/member:
    1. Click No.
    2. Enter the subscriber information in the Subscriber Information window and click Find VSP Insurance.

      If the patient has a Responsible Party designated on their Demographics record, the rest of the subscriber information automatically appears when you select the Relationship to Provider. You still need to enter the Insured ID.

    If the patient has VSP insurance, the system adds the information to the list on the Insurance screen.

Adding Non-VSP Insurance Information

  1. On the left side of the Demographics screen, click Insurance.
  2. Click + Insurance.
  3. Under Carrier Information, select the Carrier Name and Plan Name.
  4. Select whether this is the patient’s Primary Insurance.
  5. Under Subscriber Information, record the Insured ID number, or select Use Patient SSN to use the social security number in the patient profile.

    The insured ID number or social security number appears in box 1a on the CMS 1500 form.

  6. Select the patient’s Relationship to Subscriber.
  7. Record the Subscriber Name, Address, and Phone Number.

    The address appears in box 7 on the CMS 1500 form.

  8. Record the subscriber’s Sex and Date of Birth.

    The subscriber’s sex and date of birth appear in box 11a on the CMS 1500 form.

  9. Record the subscriber’s Employer.

    The subscriber’s employer appears in box 11b on the CMS 1500 form.

  10. Click Save.

    If you have Eyefinity EHR integrated with Eyefinity Practice Management, the patient’s insurance information is automatically sent to Eyefinity EHR

Adding Eligibilities and Authorizations for VSP Plans

Before adding VSP eligibilities and authorizations, you need to create a separate VSP carrier and plan for each benefit type. You can authorize insurance benefits only for the benefit type that corresponds to the VSP plan you have selected. For more information on creating carriers and plans, go to Adding VSP Insurance Information.

Follow this procedure to add a VSP authorization for an individual patient. To add authorizations for all patients with VSP insurance who have appointments at the office you are logged into on a selected date, see Pulling Multiple VSP Authorizations.

  1. On the left side of the Demographics screen, under Insurance, click Eligibility/Authorization.
  2. Locate the VSP plan that corresponds to the benefit type for which you want to add eligibilities and click +Eligibility/Authorization.

    Eyefinity Practice Management obtains the patient’s member details and eligibilities from VSP and displays them in the Eligibility/Authorization window.

    The Patient’s Additional VSP Eligibilities list displays any additional VSP benefits for which the patient is eligible. To obtain authorization for one of these benefits, create a VSP carrier and plan for it in the Add Insurance window. For more information, go to Adding VSP Insurance Information.
  3. If you are requesting a back-dated authorization, enter the date of service in the Back Date Request field, or click the calendar icon and select a date.

  4. If you are retrieving an existing VSP eligibility authorization you previously obtained using Eyefinity.com or by calling VSP Member Services, enter the authorization number in the Retrieve Existing Authorization field.
  5. Select the eligibilities for which you want authorization and click Authorize, or if you are retrieving an existing authorization, click Retrieve.

    Eyefinity Practice Management sends the authorization request to VSP.

    To manually enter the eligibilities, click Override. VSP patient out-of-pocket calculations are not performed for authorizations you enter manually. For information on entering eligibilities manually, go to Adding Eligibilities for Vision Plans Other Than VSP.
  6. An authorization number link for the eligibility appears in the Auth # column. Click the link to add notes for the eligibility.
  7. To view the VSP Patient Record Report, click the icon in the Report column.

Adding Eligibilities for Vision Plans Other Than VSP

  1. On the left side of the Demographics screen, under Insurance, click Eligibility/Authorization.
  2. Locate the plan to which you want to add eligibilities and click +Eligibility/Authorization. If the plan is not listed, see Adding Non-VSP Insurance Information
  3. Select at least one Eligibility/Authorization Type.
  4. Record the Insured Policy Group.
  5. Record the Authorization Number.
  6. Record the Authorization Date, or click the calendar icon and select a date.
  7. Record the Expiration Date, or click the calendar icon and select a date.
  8. Record any Notes you want to include with the eligibility.
  9. Click Save.

    The eligibilities appear in the Eligibility/Authorization window. To edit them, click the Auth # link.

    For an explanation of the eligibility status icons, go to Viewing Patient Insurance Information.

Adding Eligibilities for Medical Plans

When you add a medical plan eligibility, you can enter all the plan information required to quickly check out patients, including copays, deductible amounts, coinsurance, out-of-pocket maximums, provider information, and more. To edit the eligibility later, click the icon in the Eligibility column in the Eligibility/Authorization screen.

If your practice has TriZetto integrated with Eyefinity Practice Management, you can import eligibility information automatically from TriZetto. For more information, see Adding Eligibilities Using the TriZetto Integration.

Entering Medical Eligibility Coverage Details

  1. On the left side of the Demographics screen, under Insurance, click Eligibility/Authorization.
  2. Locate the medical plan to which you want to add eligibilities and click +Eligibility. If the plan is not listed, see Adding Non-VSP Insurance Information.

    The Eligibilities window opens.

  3. Enter the Authorization Number, Authorization Date, and Expiration Date.
  4. The Medical Exam check box is selected by default. If you deselect this check box, you must select at least one eligibility under Vision Coverage (see step 15).
  5. On the Coverage tab, under Individual, enter the Deductible Amount.
  6. Select whether the deductible has been met. If No, enter the Remaining Deductible Amount.
  7. Type the Deductible Renewal Date, or click the calendar icon and select a date.
  8. Enter the Out of Pocket Maximum and Remaining Out of Pocket Maximum.
  9. Select whether Durable Medical Equipment is covered.
  10. Enter the Office Copay and Specialist Copay amounts.
  11. Enter the Co-insurance percentage.
  12. Enter the Group Policy Number and Plan Number.
  13. Select whether the plan is a Coordination of Benefits plan.
  14. Under Family, enter the deductible information for any dependents.
  15. Select whether the plan includes Vision Coverage. If Yes, select the vision coverage eligibility/authorization types and enter the copay and allowance amounts.
  16. Enter the Primary Care Physician details.
  17. Click Claim Details and go to Entering Medical Eligibility Claim Details

Entering Medical Eligibility Claim Details

  1. Select whether an Intraocular Lens (IOL) Surgery was performed.
  2. Enter the Referring Provider Name and NPI Number. This information appears in boxes 17 and 17b on the CMS 1500 form.
  3. Select whether the patient has a Post Cataract Benefit.
  4. Enter the Surgery Date, Surgery Eye, and Relinquished Care Date, if applicable. This information appears in box 19 on the CMS 1500 form.
  5. Select whether the condition is related to an auto accident. If Yes, enter the Auto Accident State and Accident Date. This information appears in box 15 on the CMS 1500 form.
  6. Select whether the condition is related to the patient's employment.
  7. Check that the information under Vision and Primary Care Physician is correct and edit if necessary.
  8. Click Save.
  9. The eligibility is added to the Eligibility/Authorization screen.

Editing Medical Eligibilities

  1. In the Eligibility/Authorization screen, locate the medical plan eligibility you want to edit.
  2. Click the icon in the Eligibility column.
  3. The Eligibilities window opens.

  4. Edit the Coverage information and Claim Details, as necessary.
  5. Click Save.

Viewing the Medical Plan Summary

  1. In the Eligibility/Authorization screen, locate the medical plan eligibility.
  2. Click the icon in the Report column.
  3. The report opens in another window. Click the Print icon to print the report, if desired.

Adding Eligibilities Using the TriZetto Integration

This feature is currently only available to practices that have signed up for the Beta test and there is an additional fee required. If your practice is interested in participating, fill out our sign up form.

If your practice has TriZetto integrated with Eyefinity Practice Management, you can now obtain patient eligiblity information for TriZetto insurance payors automatically. This feature eliminates the need to access TriZetto's website to verify eligibilities.

Requirements for pulling eligibilities from TriZetto:

  • The patient's name, date of birth, and gender in Demographics and the subscriber information and Insured ID in Edit Insurance must match what the insurance company has on file.
  • A provider must be assigned to the patient in Demographics. The provider must be subscribed to TriZetto and credentialed with the insurance carrier.
  • Some insurance plans, such as MediCal, require a legacy provider ID number to retrieve eligibilties. Enter the Legacy ID in the provider's Insurance Details window in Administration. For instructions, see Setting Up Provider NPIs, Tax IDs, and Legacy IDs for Individual Carriers
  1. On the left side of the Demographics screen, under Insurance, click Eligibility/Authorization.
  2. Locate the insurance plan to which you want to add eligibilities.
  3. Click +Eligibility. If the plan is not listed, see Adding Non-VSP Insurance Information.

    The system imports the patient's insurance coverage information available from TriZetto and displays it in the Eligibilities window. The TriZetto logo in the upper-right corner of the window indicates that the information was obtained from TriZetto. The date the information was imported is also shown.

  4. If the patient's information in Demographics does not match the information the insurance carrier has on file, or the provider is missing or not valid for TriZetto or the insurance, a warning message appears when you click +Eligibility. In the message window:

    • Click Correct to correct the information.
    • Click Continue to enter the coverage information manually without using TriZetto.
  5. Check Coverage and Claim Details and edit, as necessary. Some information may not have been available for import from TriZetto.
  6. Click Save.

    The eligibility is added to the Eligibility/Authorization screen.

    Editing Eligibilities from TriZetto

    1. In the Eligibility/Authorization screen, locate the eligibility you want to edit.
    2. Click the icon in the Eligibility column.
    3. The Eligibilities window opens.

    4. Edit the Coverage information and Claim Details, as necessary.
    5. Click Save.

Deleting Eligibilities

  1. In the Insurance window, locate the plan and click the Eligibilities link.
  2. Locate the eligibility to delete, and click the Delete icon.

    You cannot delete an eligibility that has been used on an order.

    For an explanation of the eligibility status icons, go to Viewing Patient Insurance Information.

Setting a Patient’s Primary Insurance

You can designate an insurance plan as the patient’s primary insurance in the following ways:

  • When adding or editing plan information in the Add Insurance or Edit Insurance window, select the Primary check box.
  • Locate the plan in the Insurance window and select the Primary check box.

Inactivating and Deleting Insurance Plans

To delete an insurance plan, locate the plan in the Insurance window, and click the Delete icon.

An insurance plan can be deleted from the system only if the following conditions are met:

  • It has not been used on an order.
  • It does not have any associated eligibilities.

Delete the eligibilities first, and then delete the plan. For more information, go to Deleting Eligibilities.

If a plan has been used on an order, you can inactivate it. To mark the plan inactive, deselect Active.

Adding Insurance Relationships

  1. On the left side of the Demographics screen, under Insurance, click Relationships.
  2. In the Relationships window, click Assign Dependent.
    A dependent can be assigned to a single subscriber only. When you assign a dependent, any subscriber relationship previously defined for the dependent is deleted.
  3. In the Add Dependent window, perform one of the following steps:
    • To search for the dependent, type a Last Name, First Name, Date of Birth and/or Phone number and click Search. Select the dependent from the list.
    • If the dependent is not already in the system, click + Dependent to add him or her.
  4. Under Copy From Patient?, select the check boxes to copy information from the patient profile.
    If you copy contact and insurance information to the dependent but you later modify the patient’s information, the modified information is not updated to the dependent’s profile. You must manually change the dependent’s information.
  5. Record the dependent’s Name and Address.
  6. Record the dependent’s MRN (medical record number).
  7. Select a Provider.
  8. Record the dependent’s Date of Birth.
  9. Select the appropriate Gender.
  10. Select whether to use the dependent’s full SSN (social security number) or the last four digits only, and record the number in the text box.
  11. Click Save.

    The dependent is saved to the practice as a new patient, with the current patient listed as the responsible party in the dependent’s profile.