Insurance Policy Problems

This Article Discusses:

• Insurance Policy Problems
• Expiring/Expired Policy
• Pre-Certification Expiration
• Visit Limit Approaching/Exceeded
• Missing Benefit Confirmation
• Unverified Insurance
• Hide Dashboard Warnings

Insurance Policy Problems

As a provider, from the dashboard on the far right you'll notice an Insurance Policy Problems section similar to below:

As someone with Billing & Insurance access, from the left hand menu you can also click on Billing & Insurance, and see this same list on the right hand side. We discuss it briefly in the article here: Billing and Insurance Dashboard but it looks identical.

Depending on issues, 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, as demonstrated below:

Select the  Review  button to the right, to review any clients, their primary insurance listed, and problem with insurance. A sample of the top screenshot is shown below, listing each client along with their listed problem:

Clicking on any client name will navigate  to the Insurance tab on their client profile -- and any information can then be edited.

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

Expiring/Expired Policy

This problem is prompted when a client has an already expired insurance policy, or one set to expire within 14 days of the current date. 

To fix this, you'd go to the client profile and under Primary Insurance change the End Date and click [Save] as shown below:

Pre-Certification Expiration

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

To fix this, you'd go to the client profile and under  Primary Insurance find the "Pre-Authorizations" sub-section and find/change the End Date as well and click [Save] once done, demonstrated below:

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.  

Visits are automatically counted down when a session note is completed for a client visit., but they can also be viewed and edited on the client profile.

You can edit this section by going to the client profile - under  Primary Insurance find the "Pre-Authorizations" sub-section and update the Visits Used and Visits Allowed and click [Save] once done, as demonstrated below:

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.

You can manage this under the client profile under Primary Insurance section "Benefits Confirmation" seen below:

Clicking the blue + circle beside Benefits Confirmations allows you to make necessary additions, like Co-Pay and other helpful information. Listing a copay or coinsurance amount, even if it is 'zero' is the minimum data necessary to remove the problem from the alert list:

Unverified Insurance

Any client that have recently entered their insurance information via the client portal are listed as having Unverified Insurance. Your requirement here is to select the insurance company or Third Party Payer that should be billed for this client.

To verify their insurance, go to the client profile and under Primary Insurance click the orange [Verify] button to review and select the appropriate  insurance company from the dropdown option Insurance Company to assign the appropriate Third Party Payer/Insurance Company where claims will be routed to for this client:

Then

and [ Save] -- that's it!

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

Hide Dashboard Warnings