Review and Update Patient Insurance Policies

Use the “Policies” component to add, update, and work with a patient’s insurance policies and medicaid plans in PCC EHR.

Watch a Video: You can watch a short video that teaches you how to update insurance policy information for a patient: Review and Update Patient Policies

Review Policy Information

By default, the Policies component appears on the Demographics screen, and your practice can add it to chart notes, phone notes, or other PCC EHR ribbons.

The patient’s primary policy appears at the top, with a “1”, and any secondary or tertiary policies appear as well. By default, you’ll see active policies, but you can also review expired policies using the “Display” feature.

Click the disclosure triangle to see full policy information.

Policies in Practice Management

You can review and update patient insurance policies in either PCC EHR or in a Practice Management window (“Partner”).

For more information about editing policies in Practice Management, see below.

Add a Policy

When mom hands you a new insurance card, click the “Edit” button to enter Edit mode for the chart section, and then click “Add Policy”.

Next, enter policy information. PCC EHR will search for a matching insurance plan as you type.

Autofill Subscriber Information: PCC EHR will attempt to fill in the appropriate account information for the policy, based on the patient’s bill payer account. By default, PCC enters “Child” in the “Patient Relationship to Subscriber” field for a policy. For a Medicaid-type plan, PCC EHR will automatically fill in the patient’s information. You can review and change the policy information, including the Patient Relationship to Subscriber, before you save. If a sibling already has the policy you are entering, you can optionally autofill policy information from their plan.

Remember to enter a Start Date and add an End Date, when appropriate. PCC knows to bill insurance plans based on these dates and the patient’s dates of service.

If your practice bills for home visits, remember to add the complete “Zip +4” Zip Code, as insurance carriers usually require all nine digits.

Click “Save” to save the policy.

After you create a policy, you can click “Edit Policy” to make changes.

More About Patient Relationship to Subscriber: When PCC processes claims, it uses the relationship to subscriber entered for the patient’s specific policy first. If blank, PCC looks at the relationship entered in the patient’s demographics record.

Insurance Policies that Are Not Yet Active

When you add a policy to a patient’s record with a start date in the future, PCC EHR will display the “Not Yet Active” status.

In the patient’s policies list, future policies will appear above active policies. You can filter that list to review All, Active, Expired, and/or Not Yet Active policies.

Insurance Policies Shared Among Siblings

When you add or edit a policy for a patient who has siblings, PCC EHR will prompt you to update their policies as well.

You can deselect any siblings that will not have the policy, optionally enter different Certificate numbers, and click “Save” to add the policy to the sibling(s). Or you can click “Cancel” to skip adding the policy to siblings.

New Insurance Plans: When you add a policy to a patient, you pull from your practice’s official list of insurance plans, kept on your PCC system. That official list of plans is maintained in the Insurance Plans table in the Table Editor in Practice Management. For help making changes to your insurance table, contact your Client Advocate or read The Insurance Plan Tables.

Set Primary, Secondary, Tertiary and Medicaid Plans

When you edit patient policies, you can click and drag to move them to primary, secondary, and so forth.

The numbers by each active policy (1, 2, 3, etc.) will adjust for the new position on the list of policies.

PCC EHR will not allow you to move an expired policy into a primary position. It will also automatically sort Medicaid-type policies to the bottom of active insurance policies. The helpful “M” indicator for Medicaid plans will also help your practice when they need to select VFC status or make other decisions affected by Medicaid coverage.

Edit, Expire or Delete a Policy

While in Edit mode, double-click or select any plan and click “Edit Policy” to make changes.

If you click “Expire”, PCC EHR will pop yesterday’s date into the End Date field.

You can also manually change that date to whenever the plan expired. PCC uses Start and End dates to determine the responsible parties for a date of service.

PCC recommends you keep all old policies on a patient’s record. However, you can click “Delete” to delete a policy that was added to a patient’s record by mistake.

What if the policy has outstanding charges pending? PCC EHR alerts you, and prevents you from deleting that policy.

Check Patient Eligibility for a Policy

You can review patient insurance eligibility for all active policies in PCC EHR, with every visit, either during Patient Check-In or when charting the encounter.

Open the Insurance Eligibility component and check that the patient is validated for today’s visit.

Optionally, you can click a disclosure triangle to look at the Summary Report or Full Report from the insurance carrier. If you just updated or added a new policy, you may want to click “Request Eligibility” to request a new report from the carrier. You can then set a new Status, based on what you learn.

For more information about the Insurance Eligibility component, read Patient Insurance Eligibility with PCC.

Policies in pocketPCC

On your mobile device, you can review a patient’s policies in the Demographics section of the chart, or wherever the component appears.

Policies in Practice Management

You can review and update patient insurance policies in either PCC EHR or in a Practice Management window.

Read below to learn how to update policies in your Practice Management window.

Review Patient Insurance Policies (Practice Management)

Open the Insurance Policies screen (policy) to review and edit a patient’s insurance policies.

To open the policy screen, run the Patient Editor (notjane), find a patient, and then press F2 – Edit Policies.

Other Ways to See the Policy List: Many Practice Management programs have direct links to the Insurance Policies screen. For example, if you are at the first checkin screen in Practice Management, press F1 – Check Inscos or Page Down to review insurance policies for the patient. The Charge Posting (checkout) program and the Patient Editor (notjane) also have links to the policy screen.

Policies are listed briefly at the top of the screen, and the details for the selected policy are shown at the bottom:

How to Read and Interpret the Policy List

• 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.
• If any subscriber details are blank, such as the name or address, PCC 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.

Double-Coverage With a Single Insurance Plan

When a patient has two active policies with the same insurance plan (with one as secondary), PCC can send primary and secondary claims with appropriate insurance information.

Your practice can create separate policy entries for each covered person, such as each parent.

Update Patient Policies (Practice Management)

You can edit, add, move, delete, or expire an insurance policy in Practice Management. 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.

Important: You should never delete an old, expired policy. There may be account history and/or outstanding balances pending a policy, 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.

Add an Insurance Policy to a Patient’s Record

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:

Open the Patient’s “Insurance Policies” Screen

You can view a patient’s insurance policies on the second page of checkin, from the Policy key in the Patient Editor (notjane), or many other ways.

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.

Optional: Copy Details From an Existing Patient Insurance Policy

This family’s most recently edited policy is shown in the middle of the screen. Press

F5 – Use Last Modified

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 Update) Policy Details

Enter policy information in the blank fields. If you are copying the last modified plan, update information that has changed, such as the certificate number.

Keep In Mind:

• Look 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, your PCC system 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. PCC uses effective dates when posting charges and submitting claims. You can leave the date fields blank, but PCC’s claim processing 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 siblings that share the same guarantor, PCC 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 siblings.

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.

Edit an Existing Insurance Policy on the Patient’s Record

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:

Important: 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 F5 – Use Last Modified to grab the information from the previous policy. When you finish adding the new plan, use F8 – Expire Policy to expire the changed policy.

Expire a Patient Insurance 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:

Open the Patient’s “Insurance Policies” Screen

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, indicate whether or not 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 siblings.

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

Make a Policy Primary, Secondary, Tertiary (Practice Management)

When you post charges, PCC 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? PCC will link the charges to the first policy, and after you post payments and adjustments you can optionally bill the next responsible party. Therefore, you may need to adjust the order of a patient’s active policies. Follow the procedure below.

Delete an Insurance Policy From a Patient’s Record (Practice Management)

Under rare circumstances, you may need to delete a policy from a patient’s record. You should not delete expired policies under any circumstances. If any charges have been posted while a policy is active, you should not delete that policy, even if the charges were posted in error.

If you have added the wrong plan to the wrong patient, however, or the account never had a certain policy, you can do the following to remove it from the patient’s record: