Patient Plan

Allows the user to select a different plan from that entered in the New Patient form.

Carrier

If a plan has been defined as a generic plan, the user is required to enter a carrier for the plan on the Insurance form.  This permits electronic claims to be sent for generic plans.

Description

The Patient Relationship allows use to control what if anything needs to be entered for the account on this form.  If the relationship is 'self', then the patient is the account and we just got through entering all of the patient information on the New Patient form.  If the relationship is not 'self', then the account can be:

Address

Claim filing address consisting of:

The tab order will skip from Street (or P.O. Box) Address (Add'l) to the Postal Code.  The Postal Code lookup will complete the City and State.  In addition, the Postal Code lookup will default the Area Code of the telephone numbers if the Area Code is defined in Postal Code Maintenance.

Country

A foreign country may be entered if needed.

Phone

Carrier/Plan main telelphone number

Fax

Carrier/Plan fax telephone number

Phone Other

Carrier/Plan other telephone number

Eff Date

Effective date of the subscriber's insurance coverage for this plan

Exp Date

Expiration date of the subscriber's insurance coverage for this plan

Policy No

Policy number assigned by the carrier/plan to the subscriber's coverage

Group Name

Group Name (for Group Plans)

Group Number

Group Number assign by the carrier/plan to the group (for group plans

HCFA 10D

Special information to go into Box 10d - Local Use on the HCFA-1500

Medigap Number

Number assigned by the Medicare intermediary to this carrier/plan.  This need only be entered if the plan is secondary to Medicare and the practices wants to send the secondary claims as Medigap

Pre-Auth Number

Enter the Pre-Authorization Number assigned to the patient/visit by the insurance carrier.

The prior authorization number may be maintained in tw odifferent locations; one is in the Insurance Demographic and the other is on the Visit - HCFA Tab.  Please check with your system administrator to determine where you should be maintaining this value.

Coverage

Drop-down list of types of insurance coverage.  Coverage types allows a patient to have  multiple types of current and effective insurance coverage to exist.  Coverage types include:

Wait for Payment

Indicates if, during the billing cycle, whether the carrier/plan will wait at the current level for payment from the carrier before proceeding to the next level.  Default will use the plan's Wait for Payment settings.

Pt Rel

The Patient Relationship to the Subscriber allows the user to control what if anything needs to be entered for the subscriber on this form.  If the relationship is 'self', then the patient is the subscriber and since we have already entered all of the patient information on the New Patient form we don't need to enter anything for the subscriber.  If the relationship is not 'self', then the subscriber can be:

Import Patient Information

If the patient information is imported, all of the data fields on the form will be populated from the New Patient form.  The user should new override the fields that need to be changed.  For example, if the account is the patient's spouse and the patient date is imported, then the user will need to change the accounts first name, date of birth, social security number, sex, etc.  However, all of the rest of the information is 'clean' and 'correct'.

Select Subscriber

If the account is also the account holder form another patient, then the Subscriber Lookup (effectively the same as the Account Lookup) will be presented and the user can select a subscriber from a list of previously entered subscribers.

Title

Title (Mr, Ms, Mrs, etc.)

Salutation

Indicates how letters to the patient will be addressed (Dear Salutation....)  Values are:

First/M/Last

Name entered in First, Middle and Last sequence

Nickname

NickName.  Will default from patient fiest name

Generation

Generation (Jr., Sr., etc.)

Degree

Degree (MD, CRNA, Phd, etc.)

Address

Address consisting of:

The tab order will skip from Street Address (Add'l) to the Postal Code.  The Postal Code lookup will complete the City and State.  In addition, the Postal Code lookup will default the Area Code of the telephone numbers if the Area Code is defined in Postal Code Maintenance.

Country

A foreign country may be entered if needed.

Home

Home telephone number

Fax

Fax telephone number

Work

Work telephone number

Ext

Work telephone extension

Other

Other telephone number

Mobile

Mobile telephone number

Pager

Pager telephone number

Birth

Date of birth.  See date field definition for use of two/four digit years.

Death

Date of death.  See date field definition for use of two/four digit years.

Sex

Sex (Male, Female, Unknown)

Marital

Marital Status (Married, Single, Widowed, etc.)

Secondary Ins Code

If Medicare is secondary, this field indicates why Medicare is secondary.  The allowable values are "hard-coded" and conform to ANSI requirements for the field SBR05 - Insurance Type Code.

If this field is not entered on an MSP claim, the MSP Reason Code will default to '12 - Working Aged Beneficiary or Spouse with Employer Group Health Plan".