Creating a Patient Policy (CA)

The insurance billing workflow begins by entering patient insurance information inside their profile. This is done by setting up a new Insurance Policy.

An Insurance Policy is your patient’s health coverage. The policy or plan they’ve purchased from an insurance company or any other third party coverage they may have. Once an Insurance Policy has been created, it can be attached to any appointment covered by that specific insurance payer.

To add a new Insurance Policy for a patient, you can begin from two main areas; The Patient’s Profile or from their Appointment.

From the Patient Profile

From the patient Profile, you can begin by heading into the Billing tab and then clicking into Insurance Policies. Use the “New Insurance Policy” button to get started:

From the Schedule:

To start, click on the patient’s appointment on the Schedule. Next, the Appointment Panel will open up on the right, and you’ll want to scroll down to the blue Insurance Info text to expand the section. From there, click on the Add Policy button.

an image of the appointment panel when you scroll down to the insuracne info section

If a policy is already on this patient’s profile, you will see that policy listed, along with the option to add another policy in blue text.

an image of what it looks like to add a policy if there are ones listed alrady

Regardless of which way you start, the process from here is the same. First up, select the Insurer for the patient:

An image of what it looks like to select the insurer type when creating the patient's policy

Here’s our handy guide if you need to create a new insurer: Creating an Insurer.

Next, give the insurance policy a name – this is internal and should be useful in identifying the policy.

An image of where to enter in the patient's policy infomration along with a custom name for internal use, the status, authorization number and insurance plan name

The only mandatory information is the Claim Number. For insurers who don’t use claim numbers, you can use the patient PHN or another identifier.
Enter any other information you’d like to record or track on the policy. You can always return to this later to fill in more details.
You can enter default billing and diagnosis codes here, if appropriate. For insurance claims where you bill more than one item or area of treatment, you can see under all the codes you’ve added “Add Additional Billing Code.”
All of the default codes will automatically load to an appointment when you add this insurance policy.

an image of what it looks like when a dedfauly billing code is added in additon to how ot add additional billing codes

Click Save, and you’re all set. The new insurance policy will now show up under the patient’s Insurance Policies area.

Or in the Appointment Panel:

An image of what the policy looks like when viewed from the Appointment Panel

Additional Notes

Is there a way to recover a deleted patient policy?

No, deleting a policy is a permanent action and it cannot be undone. However, you can recreate the policy within a patient’s profile using the Activity Log.

To start, a Full Access user will want to head over to the Reports tab, and click on Activity Log within the left sidebar menu. If you know the staff member and the general timeframe of when the policy was deleted, you can use the filters at the top of the report to help narrow down the data.

An image of the navigational steps and where to view the details of the policy

Next, you can use your browser’s search function (i.e. on CMD + F on Mac and CTRL + F on a PC) and type in the name of the patient. Your browser will highlight anywhere the name appears on the screen, and you’ll want to watch out for the line item that says [name of the staff member] archived claim. Claim Info: [Name of the Insurer] and the policy details.

Other details, like who the policyholder is, pictures of any default coverage amounts and images of the insurance card are not recoverable at the moment.

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Creating a Patient Policy (CA)

From the Patient Profile

From the Schedule:

Additional Notes

Further Reading