4.6 - Insurance Manager

Transcription

1 4.6 - Insurance Manager Managing Insurance Claims RxWorks Inc V1.0 Manage Insurance Claims in RxWorks

2 RxWorks 4.6 Insurance Manager RxWorks Insurance Manager RxWorks 4.6 includes the ability to create insurance claims for a patient, linked to an insurance policy. Charges applied to a patient within a given date range are available to be added to the claim, provided they are not associated with any other existing claims for the patient. To make the claims process simpler, the following applies: Each claim consists of a single condition for the patient. Multiple ongoing conditions are represented separate claims. A claim can be continued, providing it is for the same condition. Claims can be supported by additional components of the patient s medical record. These are optional extras, if required by the insurance company, as evidence of the work being claimed. These components can be selected from history text, images, attachments, and lab results. Supporting materials are not limited to visits that are being claimed e.g. relevant history from an old visit can also be linked to the current claim.

3 Set up Insurance Company Information RxWorks includes a list of common insurance companies in your region. To manage Insurance Companies go to: Options & Setup B - Patient Insurance Company Setup Existing Insurance Companies are listed on the left. A filter at the top allows you to filter the companies by name and include/exclude deactivated companies. Select a company from the left to view or modify the details. Click SAVE to complete any changes. Use the ADD COMPANY and DELETE COMPANY buttons to manage the companies shown in the list. If a company has had policies or claims linked to it, it cannot be deleted & must be deactivated instead. A prompt will appear to indicate this. Note: The Setup Companies screen can also be accessed from the Add Patient Policy window. Page 3

4 Set up Patient Insurance Policies Prior to creating an insurance claim for patient, a policy must be created against the patient. This consists of basic information such as the insurance company, policy number, policy start & end dates and notes. Patients can have more than 1 policy active at a time. Previous policies can be reviewed at any time. A claim cannot be added against expired policies. To access patient insurance information, navigate to the patient record and click INSURANCE from the ribbon bar. This will launch the Insurance Claims Manager for the current patient. The Insurance Claims Manager displays in a separate work area for easy navigation between different claims. Page 4

5 Add & Edit Patient Policies If the patient has no current policies, the Manage Patient Policy screen will display. Enter the required details and click SAVE. If the insurance company is not listed, click Setup Companies to add a new insurance provider. Click Add Policy to add an additional policy for the patient. A patient can have more than 1 policy active. If a patient already has an existing policy, click the Edit button next to the policy details. Page 5

6 Creating a New Insurance Claim Prior to adding a claim, the patient must have a policy to link the claim to. Claims are managed from the patient s Insurance Claim Manager Screen. Add or Continue a Claim 1. click Create Claim from the ribbon bar. 2. Select whether this is a Continuing Claim or not. 3. For a new claim, select the policy and enter the condition being claimed. 3a. Continue a claim by selecting the existing condition from the drop down list. The list shows previous conditions that have been claimed for this patient. Page 6

7 4. Click Create to navigate to enter the details for the new claim. Basic Claim Information A claim consists of basic information such as the date range of the claim and the condition, notes for internal (clinic) use, and notes you would like to include on the claim for the insurance company. Charges included on the claim are listed on the right, grouped by visit. Treatment Dates - Automatically calculated based on selected charges. Payment To - defaults to the option selected for the policy, but can be changed for individual claims if required. Submitted Date Auto-updates when the status of the claim is changed to Submitted. Page 7

8 Attach Notes - Add notes to be included on the printed or electronically submitted claim. Internal Notes Notes for internal use only & do not print. Linking Charges to a Claim From the insurance claim page, click in the Claimed Charges section to view a visit list. Checkboxes are available next to each item/procedure, unless that item has already been included on a prior claim. Alter the date range filter as required. Check the items to include on the claim. To select all the charges in a visit, click Select All for that visit. Charges are automatically saved as they are checked. Items that have been linked to an insurance claim cannot be edited or deleted in the Visit screen. Page 8

9 Other Insurance Manager Features Linking Supporting Evidence Supporting documentation such as visit history text, images, file attachments, documents & lab results may be linked to an insurance claim. Click the manage icon in the supporting evidence section of the claim window. Checkboxes appear next to visit elements such as history text, images, lab results, & attachments. Check the box next to an element to link it to the claim. Un-checking a box will un-link the selection from the claim. Insurance Claim Attachments You can link external attachments to a claim, for example, a scan of the submitted claim form. To do this click the Attachments button in the appbar at the bottom of the Insurance Claim screen. The number of attachments linked to a claim is shown on the button. Printing a Claim To print a claim, click the Save & Print button. A modified patient history report will print including the specific charges and supporting history you have selected for the claim. Page 9

10 Claim Status The Status of the claim shows what stage the claim is at. For electronically submitted claims, the status is updated automatically. For non-electronic claims, you can manually update the status on the Insurance Claim screen. It is recommended you update the status to Submitted when you submit the claim to the insurance company and Approved/Rejected when the insurance company respond. The status affects whether payments can be linked to the claim. Deleting a Claim A claim can be deleted if it is Provisional. Once it has been marked as submitted, it can no longer be deleted. View Log Status change history for a claim can be seen in the View Log button. Online Query If a claim has been submitted electronically, you may be able to send & receive follow up information about the claim using the Online Query button. This is currently only available for claims submitted via Vet Envoy. Security There are 2 new policies to control security for claims. Policies are setup in Task Panel Tools & Utilities Policies Allow Insurance Claim Processing: Controls which users can add & edit insurance claims. Allow Insurance Claim Status Updates: Controls which users can edit the status of a claim and submit claims electronically. Page 10

11 Reviewing Insurance Claims Previous claims for a patient are listed from the Insurance button from the patient screen. Claims that have are in progress can be edited. Once a claim is marked as complete, it can be reviewed but cannot be modified. Review & Edit a Claim To review & edit the details of the claim, click the manage button. Filtering Claims The Insurance Claims screen can be filtered to find particular claims. Click the Filter button in the top right corner to display the filter options. If filtering to a single patient, the previous conditions that have been claimed are displayed in the Claimed Conditions drop down. Page 11

12 To find insurance claims for other patients, click the Clear link next to the patient name. You can leave the patient name blank or search for a different patient. Page 12

13 Link Payments to Insurance Claims Payments & Account Adjustments can be linked to Insurance Claims to aid in tracking what is owed against each claim. Payments can be linked to claims that are payable to the Vet. Claims payable to the client are paid in the normal way. If a claim is payable to Vet, both payments from the client (excess) and payments from the insurance company can be linked to the claim. Summary Bar The Financial Screen Summary Bar will show a list of any outstanding claims that are payable to vet and have a status other than Provisional. A claim is outstanding if the payments against it are less than the amount claimed. Click on the claim condition shown in the Summary Bar to navigate to the claim. Page 13

14 Allocate Payment to Claims When taking a payment, if the client has claims that are payable, the Allocate Transaction To Claims screen will display. Enter the amount being allocated to each claim. To continue to add a payment without allocating it to a claim, leave the Payment fields blank and click Next. When a payment that has been allocated is selected on the Financial Screen, the claims it is allocated to are shown in the Summary Bar. Allocate Adjustments to a Claim Account adjustments such as credits, can be allocated to payable insurance claims. When adding an account adjustment, the Allocate Transaction To Claims screen will display. Page 14

15 Editing Allocations To edit an existing allocation, right click on the payment or account adjustment and select Associate Payment > With Insurance Claim. This will display the Allocate Transaction To Claims screen and allow edits. Review Payments from Insurance Claim Screen When a payment has been allocated to an Insurance Claim, it will display on the Insurance Claim screen. Click on the payment to navigate to it. Page 15