Once the patient has been created and successfully sent to the RCM, their insurance information will need to be input to check for benefits.
Add Insurance
Let's review how to add insurance information to the patient's profile!
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- From the patient facesheet, scroll to the Payment Method/Insurance section.
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Click Manage Insurance.
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This opens in a popup window known as the iframe. The patient's primary policy shell has been added automatically with the Effective Date set today.
- Click on the Effective Date to change if needed.
- Click Create Insurance Set under Primary to select the patient's insurance company.
- 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.
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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.
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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.
- 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.
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Open the Policy Holder tab and click Edit.
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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.
- To automatically run a quick Eligibility Check, toggle on Verify Eligibility on Save.
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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.
- If the patient has a Secondary or Tertiary policy, click on the Insurance Set Effective [Date] link at the top of the page.
- 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.
- Once the insurance has been added, click Close and Refresh.
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The patient's insurance details populate on the EMR facesheet.
- Important: If the insurance termination date is added in the RCM, it will appear here automatically. Additionally, if the date is removed in the RCM, it will be removed here as well.
- Important: If the insurance termination date is added in the RCM, it will appear here automatically. Additionally, if the date is removed in the RCM, it will be removed here as well.
Add a U/R Plan
Once the patient's insurance has been added to their chart, add a Utilization Plan following these instructions.
View Insurance Card
To view the insurance card images added to the Insurance Set, click on the Insurance Card button.
Manage Insurance
When a patient gets new insurance, their profile must be updated to ensure the treatments are billed to the correct payer.
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- In the facesheet, scroll to the Payment Method/Insurance section.
- Click Manage Insurance.
- In the iframe, click on the hyperlink to begin the edit process.
- Effective Date: Click on this link to update the effective date of the insurance set.
- Primary/Secondary/Tertiary: Click on this link to update the payer, payer address, benefit information, and carveout information.
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Upon selection, the insurance set 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.
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Click Edit to edit the Payer's 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.
- 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.
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Open the Policy Holder tab and click Edit.
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Update the subscriber information and/or store a copy of the insurance card in the Policy Holder tab. At a minimum, please include Insurance ID, Gender, 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.
- Finally, click Save to complete the process
Deleting Insurance
The insurance information can be edited from the facesheet in the EMR but it can only be deleted under certain circumstances. Insurance information cannot be deleted in the RCM if claims were billed to the payer. If the payer remains unbilled, the insurance information can be deleted from within the RCM. Additionally, if the payer remains unbilled in the RCM but is associated with billable items in the patient chart, the EMR will display the deleted payer information. For more information about deleting the insurance in the RCM, click here.
If the insurance information does not update after deleting it in the RCM, please contact support for further assistance.
Eligibility
Once you've added 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.
FAQ
- This occurs when a user makes changes via the RCM iFrame in the EMR but either does not have a user account in the RCM or has a user account in the RCM but the email does not match the one in their user profile in the EMR.
- As we continue to enhance our integration with the RCM, there will be some differences in terminology between the two systems. While we continue those improvements, please refer to the tables below to clarify which terms are interchangeable.
EMR Term RCM Term Policy No. Insurance ID Group ID Group Number Plan Type Plan Insurance Phone Payer Phone Insurance Address Practice Payer Address Subscriber Information Patient Relationship to the Insured
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