Insurance Policy Problems (Home & Billing screen)

problem Insurance Policy Problems is a section of your Home screen that serves as a heads up to inform you of any potential or upcoming insurance and policy related issues with clients in your system.

In this Article:

Insurance Policy Problems

From the Home screen: look for the far right column. You'll notice the section Insurance Policy Problems shown below:


Required Role: Owner, Manager, Biller, or Therapist (financial)

Alternatively, you can click attach_money Billing (left menu).

  • You'll see this same list on the right hand side.
  • We discuss it briefly in the article here: Billing & Insurance: Dashboard (it looks almost identical)

You may have various states or alerts listed here. Anything from a green checkmark, or issues listed by their color severity and number of to the left, shown below:


Click the section you wish to review.

Here you can review any clients meeting the criteria of your selection.

  • Clicking on the Insurance Name will load the primary insurance section of their client profile
  • Clicking on the Client Name will simply load the client profile

Want to use the older insurance tab instead?

No problem! Simply click on the client name loading the profile, then click Insurance (top tab).

Insurance Policy Problems: Breakdown

Below are the sections breakdown and instructions for fixing the associated problems,

Click below to jump to that section:

Expiring/Expired Policy

When a clients insurance policy is set to expire within 2 weeks of the current date, or is already expired.

To fix this, from the report:

  • Click the client name, loading their profile
  • Find the section Primary Insurance (near the bottom)
  • To the right of the Policy section click edit edit :


  • Change the End Date by either:
    • Click the field to manually enter
    • Or clicking the calendar icon calendar_today for a date picker
  • Then click (top right)

movie Video:

Pre-Certification Expiration

Pre-Certification Expiration warnings show on the dashboard 2 weeks prior to the authorization end date or 2 visits remaining, or if the end date has already passed.

To fix this, from the report:

  • Click the client name, loading their profile
  • Find the section Primary Insurance (near the bottom)
  • Under it, find the bottom sub-section Pre-Authorizations and click edit edit :


  • Change the End Date by either:
    • Click the field to manually enter
    • Or clicking the calendar icon calendar_today for a date picker
  • Then click (top right)

Visit Limit Approaching/Exceeded

Some insurance companies and EAP's may limit the number of visits that they will cover. This alert appears when a client has 2 or fewer visits remaining on their pre-authorization.

To fix this, from the report:

  • Click the client name, loading their profile
  • Find the section Primary Insurance (near the bottom)
  • Under it, find Pre-Authorizations and click edit edit :


  • Change the Visits Allowed (or visits used)
  • When done click (top right)

Missing Benefit Confirmation

If a client does not have an amount listed in the copay or co-insurance field in their benefits confirmation section, they will be listed under Missing Benefit Confirmation.

To fix this, from the report:

  • Click the client name, loading their profile
  • Find the section Primary Insurance (near the bottom)
  • Under it, find Benefits Confirmations and click :


Listing a copay or coinsurance amount, even if it is $0.00, is the minimum information needed to remove the problem from the alert list:

Unverified Insurance

Any client that has recently entered their insurance information via the client portal are listed as having Unverified Insurance.

Your requirement here is:

  • Select the insurance company or Third Party Payer that should be billed
  • Review the remaining information input, ensuring accuracy
  • Then click (top right) when done

To fix this, from the report:

  • Click the client name, loading their profile
  • Find the section Primary Insurance (near the bottom) and look for the orange:


Not finding it here?

  • Scroll below the top active Primary Insurance policy and find the unverified policy
  • Click the edit edit button (far right):


Here we show you a page documenting what the client entered.

Tips:

  • Important client entered information can be found on top in orange
  • First, at the top ensure you select the appropriate insurance company based on the client input
  • Review for accuracy
  • When finished, click (top right)

Now, you should have a dashboard that looks more like this!


celebration Congratulations! You've cleaned up your insurance policy problems!

Hide Dashboard Warnings

Want to hide dashboard warnings for a particular insurance problem?

  • Navigate to the appropriate section previously shown above
  • Uncheck the Dashboard Warnings checkbox then click (top right)

  • The warning is now dismissed and will no longer show on your billing dashboard