Recording Insurance Information

You must record a patient’s insurance information before you bill the insurance company for any products or services that the patient purchased.

You can record up to 99 insurance carriers for each patient, but you should not change existing insurance carriers. Changing existing insurance carriers will affect prior insurance claims.

  1. Open the Patient Demographic window and verify that patient's information.
  2. Click the Insurance tab in the Patient Demographic window.

    Do not delete or modify an insurance carrier if you have already billed it for any patient charges. Deleting or modifying an insurance carrier that you have already billed will affect prior insurance claims. Instead, select the Deactivate check box to indicate that the patient is no longer subscribed to the insurance plan.

    If the patient has more than one insurance carrier, rearrange the order as needed by selecting a carrier from the list and clicking the up and down arrows. Arrange the patient’s insurance plans in the order in which they should be billed. The primary insurance should be in the first row, the secondary insurance should be in the second row, etc.

  3. Click New Ins to add a new insurance plan.

    OR

    To modify an insurance plan, select the insurance plan, select the Deactivate check box, and click New to add the plan as a new plan.

    Do not delete or modify an insurance carrier if you have already billed it for any patient charges.

  4. Select the patient’s insurance carrier from the Insurance Name drop-down menu.

    If you created a fee slip for the patient using the insurance name selected in the Insurance Name drop-down menu, you can click Claims to open, update, refresh, and print the CMS 1500 insurance form. For more information on fee slips, see Creating and Recording Fee Slips . For more information on modifying the CMS 1500 form, see Recording Additional Information on the CMS 1500 Form and ANSI File.

  5. Type the insured ID number in the Insured ID (Box 1a)text box or select the Patient SSN check box to use the patient’s social security number as entered on the Demographic tab.
  6. Select the insurance plan’s name from the Plan Name (Box 11c) drop-down menu.
  7. Type the policy group number in the Policy Group (Box 11) text box as needed.
  8. Select the patient’s relationship to the insured party from the Relationship to Insured (Box 6) drop-down menu.
  9. Select either the Vision or Medical radio button to indicate the type of insurance plan being used.
  10. If the patient has a signature on file with your office, follow the instructions below; otherwise, see step 13.
    1. Select the Signature On File check box.
    2. Select the date the signature was filed from the Date calendar.
    3. Select the signature source from the Signature Source drop-down menu.
  11. If the patient has authorized the release of his or her medical information to the insurance company so that the insurance company can process the patient’s claims, select the Release Information check box and then select the date the patient released the information from the date calendar next to the check box.
  12. Enter the Insured Party information.
    • If you selected Self from the Relationship to Insured drop-down menu, the patient’s information is automatically populated.
    • If the guarantor assigned to the patient on the Demographic tab is the insured party, select the Guarantor check box, and the guarantor’s information is automatically populated.
    • If the insured party is neither the patient nor the patient’s guarantor, click F2 Find. If the insured party is another patient, select the All Patients check box. Enter search criteria and click F2 Find. If the insured party cannot be found in the database, click New to create a new insured party.
  13. Perform the following only as needed:
    • To view the most recent CMS 1500 claim form for this patient and the selected insurance plan, click CMS Form.
    • To view the most recent UB-04 claim form for this patient and the selected insurance plan, click UB04 Form .
    • To view or type notes about the selected insurance carrier, click Notes. If a note exists for an insurance carrier, the Notes column in the table at the top of the window will have a check mark next to the insurance name.
    • To view and print a summary of the insurance plan, click Ins. Glance as needed.

    The Insurance Glance window opens and displays a summary of the insurance plan and any attached documents. If there is no information to display, no glance information was entered in OfficeMate Administration the Insurance Billing Initial Setup window. For information about adding insurance glance information, see To add & modify at-a-glance information.

  14. Click OK to close the Patient Demographic window or follow the instructions in the sections below to continue adding or modifying patient information.

In addition to the procedure above, watch this video for more information.