Patient Case: Insurance Tab

AgileRPM: Patient Case - Insurance Tab

FEATURE PURPOSE: To allow users to add Insurance Coverage to a patient's case. 

NOTE: To check-in an appointment, you will first need to make sure that the patient has insurance coverage. If a patient DOES NOT have active insurance, then the system WILL NOT allow you to check them in.

• Go to case and click on the Insurance Tab.
• Select Guarantor by clicking the drop-down and choosing the correct name.
• Add a Primary Insurance by Selecting the Add icon (+).
  • If the patient is Self-Pay, then simply check the Patient Pay checkbox and makes sure to enter the correct start/end date.
  • Add the Insurance Plan from the drop-down menu.
  • If the patient's Insurance Plan is not listed and it is In-Network, please send in a support ticket and the support team will get this Insurance Plan entered into Agile.
• Add the Subscriber
  • If the Subscriber is not the patient, add them in the patients contacts first then add them in the Insurance Tab (For more information on adding a subscriber, please view tutorial: Adding Emergency Contacts)
• Manually enter the patient's first and last name, or select Copy Patient Information.
• Enter the Policy Number and Group Number.
• Enter the Deductible amount for the Insurance Plan.
• Enter Co-Pay Amount
  • It may be in dollar form for a set amount or a percentage for co-insurance.
• Enter the Effective Date for the current Insurance Plan.
  • If you are entering a new insurance plan, be sure that the effective date does not overlap with another Insurance Coverage
• Enter the Termination date if applicable
• Enter the Allowed Visits if applicable
  • This number will show on the Patient Case Home tab under "Plan Allowed: Visits" in the Insurance chart:

• Check the Validation box once the plan and benefits have been verified.
  • If this box gets missed, then the system will not allow you to check a patient in until the Insurance Plan is validated.
  • If you are unable to check a patient in, then check in the Patients Case Insurance Tab, chances are this box may have been skipped (a red warning symbol will display on the Insurance tab). To figure out what information was missed, simply hover over this to see what was missed.
• Select Save

• Add a Therapy Cap If Applicable
  • A Therapy Cap is used for insurances such as Medicare that have limited dollar amounts that the patient can use for therapy.
• Add an Authorization
  • If the Insurance Plan requires an authorization be entered before the patient can be seen, this is where you would add this information. To access the fields to enter the auth information, ensure that the Not Applicable box is unchecked.
  • For more detailed instructions on adding an authorization, please refer to the tutorial on Adding/Editing Authorizations: https://agileemr.helpscoutdocs.com/article/416-adding-authorizations
• Adding a Medical Review
  • If the insurance requires that a Medical Review is done after a certain number of days, visits, or units billed then you can enter that information here. (Reminder: Uncheck the Not Applicable check box first.
  • For a more detailed overview of how Medical Reviews function, please view the Medical Review Manual Tutorial.
• If Secondary or Tertiary Insurance coverages need to be entered, you can enter this information by selection the addition icon (+) next to the Secondary/Tertiary Insurance Plan boxes.
  • Same process as above, once you click the (+) you will enter all the Insurance Plan information and ensure that the Validation box is selected for each.
  • When adding additional insurances, it is important that you enter all information prior to hitting the Create Coverage button, or you will have to go back in and manually enter the information all over again.
  • If you make any changes to the insurance after you have created it, you will need to click the Update Coverage button first before those changes will be saved in the Patients Case

 **If the wrong insurance information is entered on a patient's case by mistake, and it has not been billed, then you can change the insurance without marking it as an error. You are able to edit the insurance on the case until it is billed, to do so you would simply need to hit the add icon ("+") next to the insurance you are trying to change.**