Add / Update Auto Insurance Policy Details

1. Display the patient's Quickview page.
2. Scroll down to the Insurances heading and click Add case policy.
   
   The Add Policy page appears with the Case policies option selected by default.

To search using the Case Policy Lookup tool

3. Type — Select Auto Insurance from the menu.
   You can search for a policy using the Case Policy Lookup tool or your practice's Most Used Case Policies list.
4. Insurance name, address, or phone — Enter the name, address, and/or phone number of the case policy; or, enter any part of these attributes, separating each attribute with a space.
5. Click Find.
   A list of MVA case policies appears.
   Note: If you cannot find the case policy, select the I've entered all available information and can't find a match option at the bottom of the page, and then click Request New Insurance Package. The Insurance Package Requests page appears.
6. When you locate the correct case policy, click Select.
   The Add Auto Insurance Policy Details page appears.

Policy Information fields

7. Patient's relationship to policy holder — Select the patient's relationship to the policy holder.
   Note: If you select "Employee," you may need to create a Workers' Comp case policy instead of an MVA policy.
8. Policy/group number — Enter the policy or group number, if applicable.
9. Issue date — Enter or select the issue date of the auto insurance policy, if applicable.
10. Expiration — Enter or select the expiration date of the auto insurance policy, if applicable.
11. Copay amounts — Enter the copay amount in the, if applicable.
12. Coinsurance percentage — Enter the coinsurance amount, if applicable.
13. Referring provider — Enter or select the provider who referred the patient.
14. Primary care provider — Enter the patient's primary care physician, if that provider is not at this practice.
15. Pricing product type — Select the product type from the menu.
16. Notes — Enter any notes about this policy for this patient.

Policy Holder fields

If you selected Employee from the Patient's relationship to policy holder menu, follow the steps under the Policy Holder fields — Employee section.

17. Entity type — Select Person.
18. Last name — Enter the policy holder's last name.
19. First name — Enter the policy holder's first name.
20. Middle name, suffix — Enter the policy holder's middle name and name suffix (if any).
21. Address — Enter the first line of the policy holder's address.
22. ZIP — Enter the policy holder's 5-digit ZIP code. This action autopopulates the City and State fields from the athenahealth ZIP code database.
23. City — Verify the policy holder's city.
24. State — Verify the policy holder's state.
25. Country — Enter the policy holder's country.
26. SSN — Enter (or verify) the patient's security number. This field is auto-populated from the patient information.
    
    Note: Practice staff registering patients for the first time or editing registration information can enter SSNs, and can re-enter SSNs. To see the full Social Security number after it is entered, you must have the Display Full SSN user permission.
27. DOB — Enter (or verify) the patient's date of birth. This field is auto-populated from the patient information.
28. Sex — Select (or verify) the patient's gender. This field is auto-populated from the patient information.
29. Employer — Leave blank.

Policy Holder fields — Employee

Follow the steps in this section only if you selected Employee from the Patient's relationship to policy holder menu. (If you selected Employee, you may need to create a Workers' Comp case policy instead of an MVA policy.)

30. Entity type — Select Non-person entity.
31. Employer (located at the bottom of the Policy Holder section) — Click Choose to access the Employer Lookup tool.
1. Select the appropriate employer to populate the Employer fields on the Policy Details page.
2. If the employer information is not available using the Employer Lookup tool, scroll to the bottom of the list, enter the employer information in the fields provided, then click Add to populate the Employer field on the Add Auto Insurance Policy Details page.
32. Policy holder name — The employer you selected appears in this field.
33. Employer address — Enter the first line of the employer's address.
34. Employer address (ctd) — Enter the second line of the employer's address (if needed).
35. Employer ZIP — Enter the employer's 5-digit ZIP code. This action fills in the Employer city and Employer state fields from the athenahealth ZIP code database.
36. Employer city — Verify or enter the employer's city.
37. Employer state — Verify or enter the employer's state.
38. Employer country — Enter the employer's country.
39. Patient SSN — Enter (or verify) the patient's Social Security number.
    Note: Practice staff registering patients for the first time or editing registration information can enter and re-enter SSNs. To see the full Social Security number after it is entered, you must have the Display Full SSN user permission.
40. Patient DOB — Enter (or verify) the patient's date of birth.
41. Patient sex — Select (or verify) the patient's gender.

Auto Insurance Specific Fields 

42. Auto Insurance claim number — Enter the case policy number assigned by the auto insurance carrier (required).
43. Patient's condition related to — Select Yes or No for the Employment, Auto accident (defaults to Y), and Other accident menus.
    Note: For an MVA policy, Auto accident is selected by default.
44. State in which accident occurred — When Auto accident is selected (the default value on the Add Auto Insurance Policy Details page), you must enter the two-letter state abbreviation in this field.
45. Case injury date — Select or enter the date of injury for this case. (When a case policy is chosen on a claim, the current illness date field on the claim will default to the date specified here.)
46. Injured body part — Enter the injured body part (required).
47. Description of injury — Enter a free-text description of the injury.
48. Click Add Policy or Add Policy & Perform Eligibility Check. You may see this message: "There are open claims for this patient which may need to be changed. do you want to see them now?" Click Yes to display the View Claim History page or No to return to the Quickview. The policy and eligibility status message appear on the Quickview page under the Insurances heading.

 

athenaOne does not perform electronic eligibility verification for non-medical case policies, such as workers compensation and motor vehicle accident. You can set a patient's eligibility status for a non-medical case policy manually. The status you set (Eligible or Ineligible) does not expire.

Note: If your practice wants athenaOne to prompt you to confirm the patient's eligibility status every time the patient has an appointment, you can open a support case with the CSC to request this change: On the Main Menu, click Support and then click Create Case or Call.

1. Display the Update Auto Insurance Policy Details page: On the Quickview, under the Insurances heading, click Update this policy.
2. Scroll down to the Eligibility area.
3. Take action on eligibility status — Select the Override payer-returned result option.
   The New status and New reason fields appear.
4. New status — Select Eligible or Ineligible.
5. New reason — Select the reason for your update.
6. Click Update Policy.

 

For an appointment that requires an MVA or workers compensation policy, you can create a temporary case policy as a placeholder until the insurance company or party responsible for payment can be identified. Enter any information that is available (for example, injury date, injured body part, or referral information), then convert the temporary policy to an actual policy at a later date.

1. Display the patient's Quickview page.
2. Scroll down to the Insurances heading and click Add case policy.
   The Add Policy page appears with the Case policies option selected by default.
3. Type — Select Auto Insurance or Worker's Comp from the menu.
4. Click Missing policy details? Add a temporary policy (below the Insurance name, address, or phone field).
   The Add Auto Insurance Policy Details or Add Worker's Comp Policy Details page appears.
   Note: For auto insurance, the GENERIC AUTO INSURANCE [15757] package is selected. For workers compensation, the GENERIC WORKERS COMP [15444] package is selected.
5. Complete the required fields.
6. Click Add Policy.
   The patient's Quickview page is displayed.

 

After you create a placeholder MVA or workers compensation policy, you can convert the temporary policy to an actual policy when you obtain information about the insurance company or party responsible for payment.

1. Display the patient's Quickview page.
2. Scroll down to the Insurances heading and locate the GENERIC WORKERS COMP or GENERIC AUTO INSURANCE policy.
3. Click Update this policy.
   The Update Auto Insurance Policy Details or Update Worker's Comp Policy Details page appears.
4. On the upper left side of the page, click Update insurance plan.
   The Add Policy page appears with the Case policies option selected by default.
5. Search for the insurance package and select it.
   Note: You can instead select one of your practice's Most Used Case Policies from the list.
   
   1. Type — Select Auto Insurance or Worker's Comp from the menu.
   2. Insurance name, address, or phone — Enter the name, address, and/or phone number of the case policy; or, enter any part of these attributes, separating each attribute with a space.
   3. Click Find.
   4. Locate the correct policy in the search results and click Select.

The Replace Auto Insurance Policy Details or Replace Worker's Comp Policy Details page appears with the information that you entered for the placeholder policy filled in.


6. Enter or edit the policy information, as necessary.
7. Scroll down to the Replaced Policy Details section.
8. Deactivation reason — Enter the reason for deactivating the temporary policy in this field.
9. Click Replace Policy.
   The patient's Quickview page is displayed.