Adding/Editing Insurance Plans

Insurance plans are the second tier of the insurance data entry. The only requirements for completing a plan are the Insurance Carrier and the Description fields. However, for correspondence (e.g., claims submission), plans often have addresses that are different from the main address, so some care should be given to be as complete as possible.

To define an insurance plan,

1. Select Data Maintenance > Insurance Maintenance > Insurance Plans from the Main menu. The Edit Insurance Plan screen will appear.
2. Complete the plan parameters according to the following definitions.

Carrier: Click the drop-down and select the appropriate carrier with which to associate the current plan. This field is required.

Plan Number: Enter an ID up to 20 characters in length.

Description: Enter a description up to 125 characters in length. This field is required to save the record.

Bill Type, Class Code, and Balance Type: These three fields are currently used with specific billing integrations. The values are hard coded. Use them as you see fit, or ignore them if they are not applicable to your situation.

Address 1 and Address 2: Enter up to 30 characters per line in the Address fields.

Zip Code: Enter a standard 5-digit mail code. An additional 5 characters are provided for an extension.

City: Enter up to 20 characters for the city.

State: This field uses a standard 2-digit code.

E-mail: Enter up to 50 characters for an e-mail address.

Home Phone: Enter standard 10 + 5 digit extension in the phone number fields.

Work Phone: Enter standard 10 + 5 digit extension in the phone number fields.

Cell Phone: Enter standard 10 + 5 digit extension in the phone number fields.

Fax: Enter standard 10 + 5 digit extension in the phone number fields.

For organizations that have a contract with Zirmed (a 3rd party clearinghouse) to execute real-time insurance verification requests, the following information associated with the Zirmed account must be entered.

Zirmed Payer Code

Payer-Assigned Provider Number

NOTE: Additional Zirmed account information must be configured on the Data Maintenance > Integrations screen before real-time insurance verifications can be executed. See the Integrations help topic for more information.

3. Click Save to complete the plan definition. Click New at any point in the data entry process to clear the screen and prepare it for a new entry. Click Select to choose a record to edit.

Key Considerations

• A user’s ability to add or edit insurance plan data is covered by the Global User Right “Edit Insurance Plans.”
• Once at least one carrier and plan have been entered in the system, you can then associate them with a patient and enter his or her individual policy information.
• Insurance plans cannot be deleted from the system once they have been associated with a patient.
• Insurance Reports
1. Two general auditing or management reports are provided to help maintain carriers and plans:
1. Carrier Listing by Patient
2. Insurance Plans by Carrier

The first report lists all of the plans associated with a selected carrier and then lists all of the patients associated with each plan. The second report is a straightforward alphabetical listing of all the carriers in the system and the plans that are associated with each. Alternatively, users can print the second report for a single carrier.

2. In addition to the general reports, two patient reports are offered:
1. Patient Insurance Information
2. Patient Plans by Case

The first is a comprehensive report regarding all of the insurance plans assigned to a patient. The second is a slightly more general report that lists plans according to the case to which they have been assigned.