5. Managing Insurance Policies
5.1. Introduction
Your office keeps track of insurance policy information for every patient that walks through your door. Managing those insurance policies is one of the most important functions of Partner. The Insurance Policies screen, available from several different Partner programs, is your one-stop screen for reviewing and changing a patient's insurance information.
5.2. Review Insurance Policies
Many Partner programs have direct links to the Insurance Policies screen. For example, if you are at the first checkin screen in Partner, press [F1 -- Check Inscos] or Page Down to review insurance policies for the patient. The Charge Posting (chuck) program and the Patient Editor (notjane) also have links to the policy screen.
To quickly open the policy screen, simply run the Patient Editor (notjane), find a patient, and then press [F2 -- Edit Policies].
Policies are listed briefly at the top of the screen, and the details for the selected policy are shown at the bottom:
Press the up and down arrow keys to select any policy. Once you have selected a policy, full details will appear in the box at the bottom of the screen. If the list of policies is too long to fit on the screen, press [F3 -- Scroll Forward] or [F2 -- Scroll Backward] to review the entire list. Press the right arrow key to view additional plan notes for the selected policy.
When Reading the List of Policies, Remember:
If any subscriber details are blank, such as the name or address, Partner will generate claims using the information from the guarantor account. If the policy holder's address is the same as the guarantor's address, you do not need to re-enter the address on the patient's policy screen.
Unless it is expired, the first policy on the list is the patient's primary insurance. Policies are auto-sorted: expired policies are automatically moved below active policies, and Medicaid policies appear below active non-medicaid policies. You can arrange your active policies to set the primary and secondary insurances by selecting a plan and pressing [F6 -- Move Policy].
 | You should never delete an old, expired policy. There may still be outstanding balances due that company, or you may later need to know previous plan information for a patient. Instead, insert a new policy at the top of the list and expire the old policy. |
5.3. Make Changes
You can edit, add, move, delete, or expire an insurance policy with a few, quick keystrokes. While inserting a new policy, you also have the options to copy a recently edited policy or automatically add the new plan to the record of any siblings or family members. When expiring a policy, you will have the opportunity to expire the same plan for all patients in the same family.
The function keys for each task are self-explanatory:
Select a policy on the screen using the arrow keys, press the appropriate function key, and follow the prompts on the screen. The more detailed instructions in the sections below will guide you through each task.
5.3.1. Add a Policy
When a patient's insurance information changes, you need to add a new plan to their list of policies. You should do this before posting charges for the patient. Otherwise, the procedures may be billed to the wrong carrier or with the wrong information.
Follow this procedure to add a policy:
Press [F1 -- Insert Policy]
A new line will appear at the top of the list of insurance policies, and blank fields will appear at the bottom of the screen.
Enter Policy Information
Enter policy information in the blank fields.
Keep In Mind:
Looking Up the Insurance Company: For the Insurance Company field, you can use an asterisk (*) to search through your practice's list of plans. For example, entering *BCBS* would show you a list of BCBS insurance plans. Depending on how your office tracks insurance companies, typing *4624* may show you all insurances with a P.O. Box of 4624, a handy shortcut.
Override Fields: When generating claims, Partner will use the guarantor's name, address, and relationship as recorded in the fame and notjane programs. If the insurance policy holder is not the guarantor, you should fill out the name, relationship, and address fields shown above.
Effective Dates: The effective dates are very important. Partner chooses which insurance company to bill based on the effective dates. You can leave the date fields blank, but Partner will then assume that the insurance plan has always been valid and that the coverage has no known expiration.
Press [F1 -- Save]
As soon as you press F1, the new policy will be saved and active for this patient.
Optional: Copy the New Policy to Related Patients
If the new policy is not a Medicaid policy, and the patient has relatives in your system that share the same guarantor, Partner will next ask whether you wish to add the new policy to the patient's siblings. A sibling is any patient who shares a guarantor with the current patient.
Press [F1 -- Copy Policy] to continue to the sibling screen, press [F4 -- Do Not Copy] or F12 to continue without modifying sibilings.
On the sibling selection screen, confirm the position (primary, secondary, etc.) of the new plan and update any differences to the certificate and group numbers for each patient.
Press [F1 -- Save] to add the plans to the sibling records.
If you do not wish to copy the new policy to any of these patients, press F12.
Review Your Changes
Finally, you will be returned to the main policy screen. After adding a new policy, you should review all active insurance policies for the patient. Is the primary insurance listed first? Do you need to expire an old policy? Use the function keys at the bottom of the screen to make any further changes to the patient policy record.
5.3.2. Copy a Policy
When adding a new policy, you may wish to copy insurance plan information from a recently edited policy elsewhere on the account. If you recently added or edited a policy for some other patient on the family, you can automatically import the entire plan to this patient's policy record.
Follow this procedure to copy the family's most recently edited policy:
Press [F1 -- Insert Policy]
A new line will appear at the top of the list of insurance policies, and blank fields will appear at the bottom of the screen.
Press [F5 -- Use Last Modified]
This family's most recently edited policy is shown in the middle of the screen. Press F5 to copy that policy's details into the new policy fields at the bottom of the screen.
The blank fields will be filled out with all available information from the most recently edited policy.
Enter or Change Policy Information
Update any information that is different for the current patient, such as the insurance certificate number.
Press [F1 -- Save]
As soon as you press F1, the new policy will be saved and active for this patient.
Optional: Copy the New Policy to Related Patients
As with the insert policy procedure, you will now be offered the option of adding the policy to the record of other patients who share the same guarantor account.
Press [F1 -- Copy Policy] to continue to the sibling screen, press [F4 -- Do Not Copy] or F12 to continue without modifying sibilings.
On the sibling selection screen, confirm the position (primary, secondary, etc.) of the new plan and update any differences to the certificate and group numbers for each patient.
Press [F1 -- Save] to add the plans to the sibling records.
If you do not wish to copy the new policy to any of these patients, press F12.
Review Your Changes
Finally, you will be returned to the main policy screen. After adding a new policy, you should review all active insurance policies for the patient. Is the primary insurance listed first? Do you need to expire an old policy? Use the function keys at the bottom of the screen to make any further changes to the patient policy record.
5.3.3. Expire a Policy
When you add a new insurance policy to a patient, you will usually expire an old policy. When you expire an insurance policy, you will also be given the option to expire the same policy for all patients with the same guarantor.
When you wish to expire a policy, follow this procedure:
Select the Policy You Want to Expire and Press [F6 -- Expire Policy]
Enter the End Date
Yesterday's date will be entered automatically in the "End Date" field for the policy. You can enter a different date, indicating when the policy expires. The end date is the last date on which the selected policy should be billed for new charges.
Press [F1 -- Save]
Press F1 to save the policy's end date and expire the policy.
Optional: Expire Policy for Patient Siblings
Next, Partner will ask if you wish to expire the same policy for the patient's siblings. A sibling is any patient who shares a guarantor with the current patient.
Press [F1 -- Expire Policy] to continue to the sibling screen, press [F4 -- Do Not Expire] or F12 to continue without modifying sibilings.
On the Expire Policy for Related Patients screen, review the policies for each of the siblings and press [F1 -- Expire Policies] to continue. You can change which policies will be expired by deselecting them or using the selection function keys at the bottom of the screen. Press F12 to cancel and leave the siblings' policies untouched.
Toggle Detail: If you need more information about the listed policies, press [F5 -- Toggle Detail].
You can only expire policies that match the one you just expired. You will not be able to select and expire a sibling's policy unless it uses the same entry in the Insurance Companies table in the Table Editor (ted).
Press [F1 -- Expire Policies] to Expire Selected Policies
Review Your Work: The procedure above will expire a policy for one patient and any related patients you select. Remember, however, that you should always review and update each patient's policy information every time they visit your office.
5.3.4. Edit an Existing Policy
You may discover a bad certificate number, or learn that a policy is in a different parent's name and not that of the guarantor account. Follow this procedure to change information about an insurance policy that is already on an account:
First, use the arrow keys to select the insurance policy you need to edit.
Next, press [F4 -- Edit Policy] to make changes. The screen will change to allow editing, and your cursor will move to the "Insurance Company" name field.
Use the Tab, Enter or arrow keys to move to the field that needs to be changed.
When you are finished, press [F1 -- Save] to save your changes. If you make a mistake or choose not to save your changes, press F12.
 | You should never overwrite an existing policy with a new plan, even if only the address or the copay has changed. There may be outstanding charges pending the old policy or you may need to reference the family's insurance history. Instead, use [F5 -- Insert Policy]. You can then press [F4 -- Copy a Policy] to grab the information from the policy you wish to correct. When you finish adding the new plan, use [F8 -- Expire Policy] to expire the changed policy. |
5.3.5. Make a Policy Primary or Secondary
When you post charges, Partner pends them to the active insurance policy on the patient's account. But what if the account has more than one active policy? Which policy is the account's primary insurance? Partner will send the charges to the first policy listed on this screen. Therefore, you may need to adjust the order of the account's active policies. Follow the procedure below.
Select the policy you wish to move. Use the up and down arrow keys to move to the policy.
Press [F6 -- Move Policy]. You will see the screen shown below:
Use the arrow keys to move the policy where you want it. The screen will update as you move it, showing you the result of the move.
When you are finished, press [F1 -- Save] to save your changes. If you make a mistake or choose not to save your changes, press F12.
5.3.6. Delete a Policy
Under rare circumstances, you may need to delete a policy from an account. If any charges have been posted while a policy is active, you should not delete that policy. If you have added the wrong plan to the wrong account, however, or the account never should have had a certain policy, you can do the following to remove it:
Use the up and down arrow keys to select the offending policy.
Press [F7 -- Delete Policy]. You will see a warning screen.
Press [F8 -- Delete] if you are certain you want to delete the selected policy. If you change your mind and wish to keep the selected policy, press F12. Once deleted, there is no way to "undelete" a policy.
5.4. Policy Logs (policylog)
The Policy Log (policylog) program displays a log of all changes made to a patient's insurance policy record.
When an insurance policy is added, edited, deleted, or moved, Partner records that action, the time and date it was performed, and the user who made the change. If an insurance policy was accidentally deleted or changed, you can run policylog to review the patient's past insurance records. You can also review exactly when a policy was added to a patient's record, which may help explain a billing problem.
How Far Back? PCC created the policylog program in the spring of 2007. If you need help researching policy changes made before your Partner 3.2007 update, contact PCC support.
5.4.1. Running Policy Log
There are two ways to run policylog:
You can run policylog while viewing a patient's policies. First, press the right arrow key:
Next, press [F4 -- Policy Log].
You can also run policylog as a stand-alone program, either from a command prompt or from a custom entry in your Partner Windows. Contact PCC Software Support for more information.
5.4.2. Reading Policy Log
The policy log is a list of entries that describe changes made to a patient's policy record. The entries are displayed in reverse-chronological order, with the most recent changes listed at the top.
You can press Page Down and Page Up to scroll through the entries page-by-page, or press the down and up arrow keys to scroll through the list one line at a time.
Each entry in the log describes one action. For each action, policylog displays a header with the user who made the change, the date and time the change occurred, and a description of the change.
The header shown above indicates that the user "guest1" added a new primary policy on Friday, April 6th, at 5:37pm.
The body of each entry shows the details of the policy affected by the change.
The primary policy that guest1 added was a BCBS policy with a $15 copay.
More Complex Changes: When a plan is moved or modified in some way, the body of the entry will include a "Before and After" section to show the change that was made:
In the example above, guest1 changed the certificate number on the BCBS plan from 333333333 to 444444444. The policy's start date was also changed from 1/01/2007 to 3/01/2007.
Modified or Expired? Policy expiration is shown in policylog with a "MODIFIED" header. When you expire a policy, policylog records that as a modification.
5.4.3. Searching for Policy Information
If a patient's insurance record has been changed several times, it can be difficult to find specific information. Press [F8 -- Search Pattern] to perform a search.
After typing a search term, press Enter. The results of your search will be highlighted and the screen will automatically scroll to the first search result.
Press [F7 -- Search For Next] to jump to the next result.
5.4.4. Conclusion
By researching a patient's policylog record, you can recover lost insurance information, discover insurance updating problems at your practice, and improve communication in your office. Contact PCC Support at (800)-722-1082 or <support@pcc.com> if you have any questions.
5.5. Conclusion
Good insurance tracking means fewer billing and collection problems. Partner's Insurance Policies screen will help you quickly and accurately track insurance information for each patient. If you have any questions, concerns or suggestions, please let us know at 1-800-722-1082.