Add Patient: Insurance

Patient Insurance plans usually need to be added to the patient chart and the patient case, unless the patient is Self-Pay (or cash-based). The steps below show the general layout and process of adding insurance to a patient’s chart, however, the screens displayed when adding insurance to a patient’s chart vary based on the insurance type chosen (i.e., Medicare, PPO, etc.).

IN THIS ARTICLE

Add a New Insurance

  1. Navigate to the patient's chart and select Patient Info.
  2. Click the Add Insurance link.
  3. Enter the insurance name in the Insurance name field or the pre-built selection of Self-Pay for cash-based patients. Then use the radio buttons to select the patient's insurance plan (payer) from the list. If a patient's insurance plan is not listed, ensure it is added to the system
  4. Then click Next.
  5. Enter the Policy Information. The Subscriber ID/MBI is a required field. Click Next to continue.

    1. If you are integrated with a billing application, the following fields have character limits:
      • Group = 15 characters
      • Subscriber ID/MBI = 20 characters
    2. Visit Reset Date: Use this feature to update the number of visits allowed by the patient's policy, restart the visit count, or to adjust when the visit count starts for the patient. Click here for detailed instructions.
    3. Copay/Coinsurance: Entering this information helps in the scheduling process and prompts for payments.
    4. Deductible: This is not auto-calculated.
      Note: Check the  Deductible Met checkbox, if the Deductible has been Met.
    5. Insured Party: The policyholder, not the individual responsible for paying any outstanding patient balance. This defaults to Self for everyone over 18. If you change the insured party to something other than Self, the system prompts you to enter the insured party details.
    6. Summary of Financial Responsibility: Add an optional summary of the patient's insurance benefits (i.e. Deductible remaining or Copay). This information will also appear on the printed Patient Demographics attestation. 
  6. Enter the Prior Existing Treatment if Medicare is selected as the insurance. You have the option of entering the dollar amount of treatment that the patient has received for OT and PT/SLP, respectively. This information is used to alert you when you might need to use the KX modifier. Click Next to continue.
  7. Enter the Guarantor Information if the person financially responsible for payments is someone other than the patient. Click Ok to save the new Insurance. Note: The Guarantor must be at least 18 years old.
    1. AdvancedMD Integration: If the Insured Party or Guarantor is another patient—or listed as the Insured Party or Guarantor on another patient—the information entered on each patient chart must match exactly to avoid any Claims Feed Report errors. This information is case-sensitive (i.e., lowercase and capital letters).

      For example, if you enter the First Name, Last Name, Date of Birth, and SSN for the Guarantor, then you must enter the same information (First Name, Last Name, Date of Birth, and SSN) when they are listed as the Guarantor on any other patient.

  8. After adding new insurance, it is essential to apply the insurance to a specific case.

Add the Insurance to a Case

  1. To add the new insurance to a patient case, locate the patient case and click the Edit icon.
  2. Use the Primary Insurance drop-down menu to select the newly added insurance. Then click Ok.
  3. Click Save Patient, to save your changes. The newly added insurance is now applied to the patient's case.

Worker's Compensation Insurance Type

There are several required fields identified in the WebPT EMR. If you are integrated with WebPT Billing, the  Employer's Name is also required. Additionally, you must enter the patient’s Social Security Number in the Subscriber ID field.

Auto/PIP Insurance Type

The Auto Claim or Casualty Number is a required field.

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