You should have finished the tutorial 'Enter a new patient'. That tutorial walks you through the process of entering insurance information for a patient.
This section goes into more detail.
After you lookup a patient and you are at the main patient demographic entry screen. Select the '2 Insurance' button. This will take you to this screen:
To register an insurance payer for a patient, you need to enter the payer's name, the patient's IDs, group codes, etc.
From this screen you can select the patient's insurance that you are interested in editing (or you can add a new one). In the example above notice the 'Order' column on the left side of the grid. Order 1 = the primary insurance payer, 2 = the secondary, 3 = tertiary, etc. Highlight the insurance you want to edit and click the 'Edit/Revise' button or you can click the 'Add a New insurance for this patient' button. You will see this screen:
Use this screen to enter the payer name, patient IDs, group codes, etc. as well as the subscriber information. On this screen you must fill in the text box at the bottom labeled 'Default class behavior'. This will default to the value that is entered on the payer entry screen:
These are the insurance forms that the SSI® can complete: the CMS-1500, PM-160 (CHDP), and UB-92 (CMS 1450). With SSI®, it is easy to register insurance company information for a patient. We recommend that you subscribe to the software support service. If you do, you will receive updates to keep your insurance programs current.
To create an insurance claim, you need 3 pieces of information:
| 1. | the payer name, address and the patient IDs and group codes |
| 2. | the transaction that you are going to build (see the Transaction section of this manual) |
| 3. | the 'other information' on a claim form. We will refer to this as the 'Claim questions'. This information may be correct for many transactions (service lines) over an entire treatment course. In includes things like: beginning and ending dates of illness. hospital admission and discharge dates, etc. |
If you want to create a CMS 1500 insurance claim (either print or transmit) you need to select the 'Claim Questions (including EDI special information) button - see the insurance lookup screen:
click on the "Claim Questions (including EDI special information) button and - you will see a 'pop-up / drop-down' menu like this:
Select 'CMS Claim Questions.
You will see the 'Lookup CMS 1500 Claim Information' screen:
The reason for this screen is that the answers to those 'special questions' on the claim form' may change over time. For example in January you may be admitted for a heart attack and in June you are admitted for a broken leg. The lookup screen above allows you to maintain the claim questions for different periods of time. Also, if this is September and you want to create a claim for the January heart attack admission, you do not want that claim to have the information you entered in June for the broken leg. For this example, we will select the existing information so we can edit it.
Press 'Edit/Revise' and you will see this screen:
On this screen you can enter the hospital admission date (Dt Hosp From) and the discharge date (Dt Hosp To). You may also enter the dates of total disability, date of accident and other information that should appear on the claim.