Add Insurance and Verify Eligibility (Avea Integration)

Once the patient has been created and successfully sent to Avea, let's review how to add the patient's insurance and run an eligibility check. 

1. From the patient facesheet, scroll to the Payment Method/Insurance section.
2. Click Manage Insurance.
3. AveaOffice opens in a popup window. The patient's primary policy shell has been added automatically with the Effective Date set today.
   
4. Click into the Effective Date to change if needed. 
5. Click on [Create] under Primary to select the patient's insurance company.
6. Use the Practice Payer drop-down to choose the correct payer. Click Select.
   • If you can't locate the payer on in the Practice Payers list, click Add New Payer and follow the linked instructions to add an electronic payer or a paper payer. 
7. Upon selection, the Primary insurance information section will automatically open. Verify the selections for Home, Medical, and Behavioral Plan Payer are correct.
   
   
   • If there is a Medical or Behavioral carveout noted in the policy, and those claims need to be submitted to a different payer, click on the Change link.
   • Select the appropriate carveout payer, then click Select. 
   • The selections made here determine where claims are submitted. In the example chosen here, the patient has Aetna as their Home and Medical payer and a Behavioral carveout to Beacon Health Options. 
8. Click Edit to add Payer Phone and Address information.
   • An address is required for claims that will go out on paper. If the address information is not entered in Practice Admin > Payers or a different address or phone number is needed, toggle off Use Practice Payer Address and complete the address information.
9. Open the Policy Holder tab and click Edit.  
10. Enter subscriber information and store a copy of the insurance card in the Policy Holder tab. At a minimum, please include Insurance ID and Patient Relationship to Insured.
    • If the subscriber is someone other than the patient, please ensure the Subscriber First Name, Last Name, Date of Birth, Gender, Address, City, State, Zip, and Phone fields are completed for accurate billing.
    • If the patient has a carveout, please make sure you document both sets of Insurance IDs and Group Numbers when applicable. 
    • Any images added of the Insurance Cards will be accessible from the EMR facesheet through the Insurance Card button.
11. To automatically run a quick Eligibility Check, toggle on Verify Eligibility on Save. 
12. Next, click Save. If you've chosen to verify eligibility, you'll receive a verification notification. Eligibility information can be referred to under the Eligibility tab.
13. If the patient has a Secondary or Tertiary policy, click on the Insurance Set Effective [Date] link at the top of the page. 
    
    
14. Click [Create] under Secondary and follow the same process as described above to add the patient's secondary insurance. Once a secondary is added, the [Create] field for Tertiary becomes available.  
    
    
15. Once the insurance has been added, click Close and Refresh.
16. The patient's insurance details populate on the EMR facesheet.
    
    
    • Important: If the insurance termination date is added in Avea, it will appear here automatically. Additionally, if the date is removed in Avea, it will be removed here as well.

Eligibility

Once you've added an insurance to the patient chart, you can complete an eligibility check at any time using the Eligibility button.

From the Eligibility window, select the Service Date and Service Type. Then, click Check Eligibility.

The system will return an Eligibility result. Check out the Eligibility article for complete information on coverage responses and errors. 

View Insurance Cards

To view the insurance card images added to the Insurance Set, click on the Insurance Card button. 

Add U/R Plan

Once the patient's insurance has been added to their chart, add a Utilization Plan following these instructions.