Adding primary insurance details to the patient profile is essential if you want to auto-populate all details in the HCFA form. This makes the claim generation process easier as every time you submit a claim for a given patient, the primary insurance details will be fetched from the patient’s Primary Insurance to the HCFA form.
1. Enter the first or last name of the patient in the Search box at the top of the navigation bar on the zHealthEHR dashboard. Click Enter.
2. Click on the desired patient name to edit information. The Patient’s Profile will open.
3. On the Profile window, click on the third option - Contact Details.
4. On the left side, browse through the options and click on the fifth option - Primary Insurance. The Primary Insurance section will open.
5a. Click on the Select button. A new pop-up window will open.
5b. The new pop-up window contains a list of all insurance payers.
You can search for the insurance payer by typing the name on the Insurance lookup search box. Or you can click on the radio button in front of the ‘New Insurance’ option at the top.
5c. Search the name of the insurance payer in the lookup box. If the payer exists, it will be displayed in the search result.
Click on the green-colored ‘Select’ button to add the desired insurance payer to the patient profile. The pop-up window will close automatically.
6. If the patient is self-insured, you will have to click on ‘Self.’
If the patient is dependent on the insured person, click on Spouse or Child or Other depending on whether the insured person is a spouse, child, or have other relationship with the patient.
7. A drop-down form will open if you click on Spouse, Child or Other. Fill the form to provide information on the insured:
8. If the patient’s insurance card shows copay details, Select Dollars or Percentage and then enter the Copay amount in the box.
Note: If deductible is known, you can enter the amount in the box "Deductible." For any additional notes, enter the details in the "Notes" box.
9. Make sure the checkbox for Authorize payment benefits to the provider (HCFA Box 13) is ticked if you want to receive the insurance payment to your account. Otherwise, the insurance payment will be sent to the patient.
Note: Box 13 in the HCFA Form will automatically show the ticked checkbox that will ensure you receive the insurance reimbursement and not the patient.
10. If the insurance company requires you to provide the referring physician's name, select the appropriate category from the drop-down menu under Referring Provider OR Other Source (Box 17).
Also, enter the referring physician's first, middle, and last name in the box - Physician Name (Box 17).
Note: Box 17 in the HCFA Form will automatically pull the referring physician's name and category during claim submission.
11a. Enter the NPI of the referring provider in the Physician NPI Number (Box 17b).
11b. Enter the other ID (such as State Licence Number, UPIN Number or Provider Commercial Number) of the referring in the Physician Other ID (Box 17a).
Note: Boxes 17a and 17b in the HCFA Form will automatically pull the referring physician's NPI and other ID.
12. Box 19 is used to identify additional information about the patient's condition or the claim. Enter additional information about the claim in the box - Additional Claim Information (Box 19).
Note: Box 19 in the HCFA Form will automatically pull the Additional Claim Information under Primary Insurance.
13. If the patient’s insurance company requires prior-authorization, click the "Edit" icon to add Prior Authorization Number (Box 23) to the patient chart. Once you click the Edit icon, a pop-up window opens.
On the pop-up window, enter the following information to add multiple Prior Authorization Numbers:
a. From the drop-down, select the appropriate category
b. Enter the Prior Authorization Number
c. Enter the description
d. Click "Save"
Repeat the four steps (a-d) to add more Prior Authorization Numbers.
A clinic can use multiple Prior Authorization Numbers for a given patient insurance and use different codes for different claims.
To deactivate a Prior Authorization Number, click the "Cross" icon to deactivate the code. Or click the "Tick" icon to activate a code.
14a. If the patient's condition is related to Workers' Compensation/Employment, Auto Accident, or Other Accident, providers must complete this section - Is the condition related to? Click the radio button to indicate if the condition is related to WC/Employment, Auto Accident or Other Accident.
14b. Enter Claim Number in the box Claim# Box 11b.
14c. If Attorney Information is available, providers can enter the details under "Attorney Information" under the Primary Insurance section.
Note: Boxes 10a, 10b, 10c, and 11b in the HCFA Form will automatically pull the Claim# under Primary Insurance if the condition is related to 'employment' i.e. work compensation or auto accident. The EDI 837 will also have the Claim# in workers' comp cases.
15. Click ‘Save’ to save this information to the patient profile.
The primary insurance information will be added to the patient profile.
16. Once you save the Primary Insurance details, the following changes happen:
a. The 'Select' option on the top automatically disappears after you add an insurance to the Patient's Contact Details.
b. If you want to add a new insurance for this patient, click on the "Add New Insurance" button on the right side of the screen. Clicking this button will bring the 'Select' option again. Then click that 'Select' option to add a new insurance.