Billing

Configuring Patient Insurance

• Configuring Insurance Settings
• Adding Patient Insurance
• Insurance Card Reader

Configuring Insurance Settings

Practices can preset the settings to Release Medical Information of the Patient and Assign Medical Benefits under the 'Settings > Billing-Claims > Insurance Settings' section. Any value chosen here gets populated by default while adding new Patient Insurance.

Practices are also allowed to choose a different Policy Type Code for a specific Insurance under the 'Patient Insurance' Section.

• Release Medical Information: Choosing the option 'Yes' in this field indicates that the Practice has obtained consent from the Patient to release the medical information to the Payer.
• Date of Signature for Release Medical Information: This field indicates the date when the Practice has got consent from the Patient to release the medical information to the Payer. You can set it to show the 'Patient Registered Date' (or) 'Insurance Added Date' as the default value while adding the Patient Insurance. You can also set it as empty so that no date will be selected by default.
• Assign Medical Benefits: This indicates whether the Patient has authorized the Payer to provide the benefits/payments directly to the Provider/Practice.
• Default Policy Type Code: When MEDICARE is selected as Secondary Insurance in a Claim, the 'Policy Type Code' is required to be submitted in that Claim. The Practice can configure the default 'Policy Type Code' under this Insurance Settings field.
• Prior Authorization Settings: CharmHealth allows the user to add Prior Authorization specific to a Provider. This helps to track the Patients' visits based on a specific Provider. When a Prior Authorization gets configured for the Provider, the order of the Providers arranged in the 'Prior Authorization Provider' setting will be followed for Prior Authorization counter calculation. The Practice can re-order the Providers as per their preferences.

Note: Updating this setting will not impact the existing Patient Insurance.

Adding Patient Insurance

Practices can add new Insurance for a Patient from the Patient Dashboard.

1. Navigate to 'Patient Dashboard > Patient Details > Insurance'
2. Click the '+ Insurance' button.
   

Insurance Details

• Type: This field represents the type of Insurance the Patient has. The common options include - MEDICARE, MEDICAID, TRICARE CHAMPUS, CHAMPVA, GROUP HEALTH PLAN, and FECA BLK LUNG.
• Plan or Program Name: This field indicates the specific Plan or Program under which the Patient is covered.
• Patient Insurance ID: This field requires the insurance ID number of the Patient. Practice can select whether the patient has a unique Insurance ID or shares an Insurance ID with an insured person (such as a family member).
• Policy Group/FECA: This field is used to enter the Policy Group number or Federal Employees’ Compensation Act (FECA) number associated with the Insurance policy.
• Policy Type Code: When MEDICARE is designated as the Secondary payer, a specific Policy Type Code must be used to reflect this status accurately. This field is used to identify the type of Insurance policy or coverage provided and will be available only for MEDICARE.

Payer Detail

Adding Payer Name

Practices can choose a Payer for an Insurance through one of the following methods.

1. Choose from the Pre-configured list of Payers
   If Practice works only with a defined set of Payers, they can enable the 'We work with pre-configured list of Payers...' setting under the 'Settings > Billing-Claims > Payers' section. This allows the Practice members to choose a Payer from a list of verified Payers added under the 'Practice Payers' setting. To know more about this setting, Click Here.
2. Search and Choose from the Existing Payer List
   
   1. Practices can search and select the Payer from the Practice Payer List added under the 'Settings > Billing-Claims > Payers' section.
   2. If there is no Payer in the Payer list, the entered Payer name will be added as a new Payer.

Configuring Patient Consent Details

• Release Medical Information: Choose 'Yes' if the Patient has authorized the release of medical information and select the appropriate date.
• Assign Medical Benefits: Choose 'Yes' if the Patient has assigned Medical Benefits to the Provider.

Insurance Category

Select the appropriate category for the Patient's Insurance. The options include:

• Primary: The Primary Insurance that will be billed first.
• Secondary: The Secondary Insurance to be billed after the Primary Insurance.
• Tertiary: The third Insurance Payer, if applicable.
• Auto (PIP/MVA): Insurance related to personal injury protection (PIP) or motor vehicle accidents (MVA).
• Worker’s Comp: Insurance related to worker’s compensation claims.
• Other: Any other type of insurance not covered by the above categories.

Note: Whenever a new Insurance is added, it gets added as Primary insurance, and the existing Primary Insurance will be updated as Secondary Insurance.

Filling Insured Details

• Patient Relationship: Select the relationship of the Insured person to the Patient from the drop-down menu. The options include:
  
  1. Self: The patient is the insured person.
  2. Spouse: The insured person is the Patient’s spouse.
  3. Parent: The insured person is the Patient’s parent.
  4. Child: The insured person is the Patient’s child.
  5. Other: The insured person has another type of relationship with the Patient (e.g., legal guardian, friend).
  6. Employee/ Other: The Insured person is the Patient's Employer for Worker's Compensation Insurance.
• Fill Guarantor Details: Enable this option if the Insured Person is the Guarantor to the Patient.

Patient's Condition-Related Details: Practices can add Illness/Injury Dates to the Insurance by filling out the below details.

1. Choose the Patient's condition - Employment, Auto-Accident, or Other Accident. If the condition is related to an Auto-Accident, select the Auto-Accident State.
2. Illness/Injury date - Choose the date when the Illness or Injury occurred.
3. Date Qualifier - Select the date qualifier that describes the type of date being entered - Onset of Current Symptoms or Illness Date, Last Menstrual Period, and Initial Treatment.
   
4. Practices can configure more than one Illness/Injury Date using the '+ Add More' option.
5. When there is more than one date, the latest 'Illness/Injury Date' from the Insurance will be auto-populated to the Claim.

Additional Details

• Other Claim ID: Practices can add the Workers' Compensation Claim Number or Accident Case Number directly to the Insurance information. This data will be automatically included in the Claim (Box# 11b) when it is generated.
• Insurance Eligibility Details: The Insurance Eligibility Check verifies whether the Patient’s insurance policy is active and covers the services to be provided.
  
  1. Real-time Eligibility Check: Practices can do the Insurance Eligibility Check by clicking the 'Check Eligibility' button under the 'Patient Dashboard > Insurance' section. On successful Eligibility Check, the Eligibility Status, Policy Valid Dates, Copay, Deductible, and Co-Insurance details get updated to the Patient's Insurance.
  2. Automatic Eligibility Inquiry: Practices can automate Insurance Eligibility Inquiries when the Patient's Primary Insurance gets added by configuring the setting under 'Settings > Billing-eClaims > Real Time Eligibility Settings'.

Prior Authorization Details

• Prior authorization obtained from the Payers can be added in the Patient Insurance section.
• The Prior authorization details contain Prior Authorization numbers issued by the Payer, Type, and Validity dates.
• This Prior auth number will be automatically filled in the CMS1500 form when a Claim gets generated for the Patient.
• Prior Authorization can be added either for a combination of factors, such as an Allowed visit, Procedure Code, and Provider, or it can be applied to each element individually.

To learn more about Prior Authorization and Visit Counter Tracking, Click Here.

Uploading Patient's Insurance Card

Practices can also upload the Patient's Insurance Card to add the Insurance details.

Insurance Card Reader

This feature allows Practices to upload the Patient's insurance card and automatically fill in all the insurance details by scanning the insurance card. Click Here to learn more about Insurance Card Reader.