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Chapter 6: 🇨🇦 Canadian insurance

  1. Front-Desk Training
  2. Chapter 6: 🇨🇦 Canadian insurance

    3. 13 min read
    Practice Plan Thrive Plan

💡Jane tip: We recommend heading over to Jane’s Demo Clinic to practice as you learn! Contact us to request the password or check out the Facebook community group where the password is posted each week.

In this chapter, we’ll walk through everything you need to know about handling Canadian insurance billing in Jane. This guide will give you a clear, step-by-step overview of how to set up and manage insurance claims in Jane, with an emphasis on third-party billing.

Note: The features covered in this chapter are only available to clinics in Canada on our Insurance Plan. Looking for training on US insurance billing? Check out this Guide.

Getting started with insurer setup

Depending on your patients’ insurance providers, you likely need to use different methods for submitting claims. We recommend setting up all your insurer integrations first and third-party insurers after so you can add patient policies and start submitting claims right from the first appointment.

To make your life a little easier, Jane offers direct integration with a few Canadian insurers. Setting up and submitting claims through these integrated insurers helps save time and automatically tracks payments within Jane. Additionally, some insurers offer the added benefit of eligibility checks through providers like TELUS eClaims.

Since each integration is set up differently, we’ve created individual Guides for some of the most common insurers to walk you through the process. To learn about setup, claim submission, and payments for these integrations, check out the following guides:

We recommend setting up these integrated insurers before moving on to adding your 3rd party insurers, which the rest of this chapter will focus on.

Within Jane, you’ll see the words “insurer,” “policy,” and “claims” sprinkled in a few different areas. So, you may be wondering, ‘What is the difference between an Insurer, a Policy and a Claim?’. Let’s take a look:

  • Insurer: Any insurance company that your clinic is set up to submit claims to. Your clinic can set up multiple insurers in Jane. Each insurer has their own rules and standards for how they like to receive claims. Clinics must follow these rules to be paid back properly.
  • Policy: A patient’s agreement with their insurance company. In Jane, the policy is added for each patient with their individual policy, group, or plan numbers and details.
  • Claim: A request for payment from a visit by clinic to an insurer. Each claim includes the policy details and specific information about the visit.

The 🇨🇦 insurance billing workflow from start to finish

Let’s get started with a video that will walk us through an overview of the steps involved in billing to a 3rd-party. We’ll explore each step in more detail below, so you’ll know exactly what to do — and when.

Step-by-step insurance billing to a 3rd-Party

Step 1. Setting up your insurers

Step 2. Creating a client insurance policy

Step 3. Booking an insured visit and submitting a claim

Step 4a. Marking a single claim as submitted [from the appointment]

Step 4b. Updating multiple claim statuses [from the Billing tab]

Step 5. Reconciling an insurance invoice once payments have been received by the 3rd Party

And if you’d like you can head on down to our Additional Resources section.

Step 1. Setting up your insurers

To get started, a Full Access user on your team will need to add your clinic’s insurers.

Go to Settings > Insurers > New Insurer to begin.

Watch the full walkthrough:

More help: Creating and setting up insurers

💡 Jane tip: If your third-party insurer has a submission portal, add the Portal URL when setting up. That way, launching it later is just one click away.

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Step 2. Creating a client insurance policy

Before a client’s appointment, take a moment to set up their policy in Jane. This saves time and keeps everything smooth at check-in.

You can collect insurance details through the Insurance Information section of your intake forms: Here’s how.

You can add policies from:

  • The Patient Profile, or
  • The Appointment Panel in the schedule view

To add a policy from the appointment panel:

  1. Click Add Policy > New Policy
  2. Fill out the patient’s insurance info
  3. Click Save

That policy will now be linked to the patient’s account.

Practice drill

Let’s try out entering patient insurance information.

Instructions:

  1. Ryan Anderson is ready for his appointment at the Demo Clinic. He is seeing the clinic for low back pain.
  2. Ryan let you know he has insurance coverage available with Manulife and has handed you his Manulife card. The card has a Policy #37895 and ID#10.
  3. Navigate over to Ryan’s profile and head into the Billing tab.
  4. Next, click into the Insurance Policies tab.
  5. Use the New Insurance Policy button in blue to save Ryan’s Manulife policy information.

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Step 3. Booking an insured visit & submitting a claim

Once you’ve created and saved a patient policy, you can start insuring your patient’s visit(s).

🎬 Let’s watch this in action:

From the appointment panel:

  • Go to Insurance Info
  • Click Add Policy, then pick the one you saved earlier

Jane will automatically split the invoice. For example, with 80% coverage, Jane will show $48 for the insurer and $12 for the patient.

In order to get paid, we need to let the insurer know that they owe us this outstanding amount. Click Arrive to generate the invoices.

You’ll now see:

  • An invoice for the patient’s portion
  • A second invoice for the insurer’s portion

At this point, the insurance claim will still be marked as unsubmitted. Click the blue insurer name at the top of the appointment panel to open the claim management screen.

On the next screen, you’ll find everything you need to submit the claim through the portal.

To submit the claim:

  1. Click the insurer’s name
  2. Then select Launch Portal
  3. After submitting, close the portal window, and check that Jane’s estimate matches the insurer’s confirmation.

Let’s click the “X” in the top right-hand corner of the window to exit the claim management screen, and navigate back to the Insurance Info section in your appointment panel to confirm that the amount the insurer said they’d cover, and the amount Jane thinks they will pay is the same amount.

If they match — great! You’re ready to collect payment from the patient.

If not, here’s how to adjust the insurer’s amount.

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Step 4a. Marking a claim as submitted [within the appointment]

Once the invoice reflects the correct amount, mark the claim as Submitted so Jane knows you’ve sent it off.

You can do this right from the appointment panel:

  • Click the drop-down arrow next to the claim
  • Choose Mark as Submitted

This just tells Jane that we’ve done our part—now we’re waiting on payment from the insurer.

Another way to mark claims as submitted (especially in bulk) is through the Billing tab. That’s coming up next.

After that, you can collect the patient’s portion of the payment.

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Step 4b. Updating claim statuses [from the Billing tab]

As mentioned above, many of our clinics will use the Billing tab in the top blue bar to manage multiple claims at once within the Claims Submissions section.

To navigate to this area, select Billing > and scroll down to the Claim Submissions on the left.

Although we recommend submitting your claims at the time of the appointment to ensure you are collecting the accurate amount from your clients, some clinics may prefer to update the status of their claims all at once at the end of the day.

Let’s take a look at three of our important claim submission folders to the left to help keep things organized:

  1. Unsubmitted folder: This folder contains all of your claims that have been added to an appointment, but have not yet been marked as submitted.
  2. Submitted folder: This folder contains the claims that have been marked as submitted (i.e., you’ve submitted the claim through the portal or by mail) and are awaiting remittance/payment from your insurer.
  3. Approved folder: This folder contains your claims that have been paid. Claims will automatically move to your approved folder from the submitted folder once a payment has been received. We’ll take a look at how to reconcile an outstanding insurer invoice in Step 5.

If you’d like to learn about the Draft folder vs. the Unsubmitted folder, you can visit this guide here.

🎬 Let’s take a quick peek at the folders we mentioned above in the below video:

To submit a claim from the Unsubmitted folder, just click on the claim, then Mark as Submitted.

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Step 5. Reconciling an insurance invoice once payments have been received by the 3rd Party

You’ve made it to Step 5! Great work, this is the final step. 💙

Within this step, we’re assuming that you’ve received payment from the 3rd party payer or insurer. So, what we’ll want to do next is record the payment in Jane so that Jane knows to move your submitted claims over to the Approved folder and mark them as paid. This step is crucial for tracking which claims have and have not been paid by insurers.

Let’s take a look at this quick video to see how to do that. You can jump to [1:10] to skip the refresher intro. ⏭️

As with many areas of Jane, there are multiple ways to do things! Although we recommend recording payment under Billing > Insurer Invoices, you do have other options. If you’d like to learn more ways to apply a payment to an outstanding insurer invoice, click here.

Practice drill

Let’s record a 3rd party payment received by Manulife.

Instructions:

  1. You just got paid by Manulife! 💸
  2. Let’s click into the Billing tab in the top blue bar, and scroll down to the Insurer Invoices section. Click on Manulife.
  3. Click the New Payment button in the top right-hand corner.
  4. Next, select a payment method from the drop-down menu, add reference # 001122, and enter $200.00 into the Amount $ field. Click Next.
  5. Now that the payment is saved, select the blue Apply button to the invoices listed until the total amount has run out.
  6. Bonus ✨ Use the search field to enter in a client name or invoice number if you’re looking to apply the 3rd Party payment to someone specifically.

Finally, let’s take a quick look at how to add a claim to an insured product.

You did it! That’s the entire process from a-z. Next, check out some further learnings.

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Additional resources

If you’d like to read more about our Canadian Insurance workflows [billing to 3rd parties], you can browse our below guides:

Great work! Nothing can stop you now! Time to celebrate in Chapter 7.

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