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The Insurance Estimating Use Guide contains the following sections:
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You can also refer to:
Setting Up Insurance Estimating Charges
Portion TroubleshootingInsurance Estimating Overview & Formulas
Insurance Estimating
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Charges
When Insurance Estimating has been correctly configured, the Insurance Estimating Formula variables for each code, such as the patient portion, allowed, write-off, insurance portion, and so on, will display within the code table at the bottom of the New Charge window. The total amount for each variable of all codes within the transaction will be listed beneath the table.
The variables are listed within columns.
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Fee: from the Fee Schedule and Charge
Patient Portion: the percentage of allowed amount that the insurance does not cover minus the write-off, if participating
Primary Write-off: the difference between the allowed amount and the fee, if participating
Primary Allowed: the allowed amount in the Plan
Primary Insurance %: from the Plan
Primary Insurance Portion: what the insurance will pay according to insurance estimating
Primary Deductible: The amount applied to the patient's deductible
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Information within References > Insurance Companies > Plan will override both the Company Info and Provider IDs tabs whenever the plan is associated to an account.
Insurance Payments
The Insurance Payment window can be used to add allowed amounts to the Allowed tab the Allowed tab of a plan as an insurance payment is made. If an allowed amount is entered with the payment, but there is not an allowed amount for that code within the plan, the Save Allowed checkbox will be checked in the insurance payment window and the corresponding allowed amount will be saved to the plan. From then on, the same allowed amount will pull to the Insurance Payment window for that procedure whenever the patient has this plan. If the provider has Participate checked for that plan, the write-off (total fee - allowed amount) will also populate in the Insurance Payment window. To override this process, uncheck Save Allowed and no allowed amount will be added to the plan.
As with Allowed Amounts, the Insurance Payment window can also be used to add Flat Rates to add Flat Rates to the patient's plan. When an insurance payment is entered, check the Save As Flat Rate checkbox in the insurance payment window to save the allowed amount as a flat rate for the code within the plan.
When Insurance Estimating is used, the Insurance Payment window will include the Apply To Unpaid checkbox, which determines how the Apply to All button works. Apply to All will only apply up to the total estimated insurance amount unless the Apply To Unpaid checkbox has been enabled, in which it will then apply to the entire unpaid portion.
For general information on entering Insurance Payments, see the Insurance Payments documentation.