Patient Facesheet: Insurance

The Insurance Information section of the facesheet allows you to capture insurance information for the patient, including front and back images of their insurance card. Insurance information can be added to a patient's facesheet when the patient is created or at any time thereafter.

Note: If your facility uses Kipu RCM (Avea), follow the instructions found here instead.

Add/Edit Insurance Information

For specific instructions on adding a new patient, check out this article. To edit an existing facesheet, click on the desired patient tile, then from the Information tab, click Edit Patient (or Client, etc. depending on your facility's preferences).

1. Scroll down to the Insurance Information section and click the Add Insurance button.
2. Begin typing the patient's insurance into the Insurance Payer field, then select the correct option from the list. This is a required field.
1. If your facility uses VOB Getter, free text is not supported. For more information on the insurance options that appear in this field, check out this article.
2. The insurance information is color-coded:
   • Blue: Payor eligible for benefit verification through VOBGetter in the EMR or CRM.
   • Red: The custom shortcode created on the Payers tab. 
   • Black: The payor name.
   • Green: Internal Kipu ID
   • Purple: External Payer ID (from payer settings). Selecting a payer with an External Payer ID is critical for organizations integrated with CMD.
3. Type in the policy number and choose the effective date. These are both required fields.
1. Note: Ensure that there are no spaces, slashes, or dashes in the Subscriber ID field and that the date entered is correct, as this data can impact eligibility and coverage.
4. If your facility has integrated billing or the billing audit tool, you will see the Show Inactive Insurances toggle once the effective date has been added. By default, the toggle is enabled, showing all insurance entries on the patient's chart. If the toggle is disabled, all inactive insurances will be hidden.
   

Add/Edit Subscriber Information

Next, add the subscriber information.

1. Click on the Relationship of Patient to Subscriber field and select the correct option. If the subscriber is not known, or any of the required information for the subscriber is missing, select Self. This field is required.
2. If Self is selected, any information present elsewhere in the facesheet will be automatically entered. The subscriber's first and last name, date of birth, gender, state, and zip code are all required.
3. If needed, you can click the Copy Insurance button to duplicate an insurance entry.
   1. Note: All fields except Insurance Payer, Internal ID/External ID, Termination Date, Claims, Insurance Card (front)/(back), Notes, Insurance Verification, Add Form button/details, Hx and all VOBGetter information will retain the original data in the copy. The listed fields will become blank.
4. Click Choose File in the Insurance Card (front) and (back) fields to upload images of the patient's insurance card, if needed.
5. Add notes, as needed.
6. If your organization does not use VOBGetter, or manually verifies insurance, click on the Insurance Verification button and fill out the form. For more information and instructions, click here.
   1. Once you create the form, a VOB Form button will appear, which you can click on to view the form.
      
7. Click + Add form to add any insurance-specific forms to the patient's chart.
   1. Click on the form name to preview, click Add to add the form to the chart. 
8. You can delete the insurance by clicking X Delete Insurance. Do note, however, that if the insurance has already been used to bill data to an RCM system, you cannot delete it for data integrity reasons.
9. Click on VOBGetter Instant. to use the VOBGetter. For more information on verifying benefits, check out this article. Status, Request, Control Number, and Kipu Insurance ID are all related to VOBGetter, and will populate with results. The Hx button will open a VOBGetter History window, where you can review all VOBGetter results.
10. Selecting the Exclude from scheduling checkbox will prevent the client's eligibility from being automatically checked during the weekly batch.
    1. Note: This automation used to occur on Tuesdays, but is not running at this time. 

Read View

The read view of the insurance portion of the facesheet appears as follows.

As in the Edit view, you can verify insurance, add forms, and run the VOBGetter.