Quick Reference — To add an insurance policy

athenaCollector

1. On the Quickview, under the Insurances heading, click add new.
   The Add Policy page appears with the Standard policies option selected by default.
2. Search for and select the policy name in the insurance packages list. (For detailed information about locating the correct package, see Add Policy.)
   The Add Policy Details page appears.

Policy Information

3. Patient's relationship to policy holder — Select the patient's relationship to the policy holder. If you select "Self," athenaOne auto-fills several of the policy-holder fields.
4. Member ID/certification number — Enter the patient's member ID number from the patient's insurance card.
   (This field populates box 1a on the CMS-1500 form.)
5. Policy/group number — Enter the patient's group number from the insurance card.
6. Issue date — Enter or select the issue date of the policy.
7. Expiration — Enter or select the expiration date of the policy.
8. Copay amounts — This field defaults to Office Visit. Enter the copay amount for an office visit in the $ field to the right of the menu. This amount appears on the Check-in and Checkout pages when you collect patient payments.
   Note: If you leave the Copay amounts field blank, athenaOne may auto-populate the Office Visit copay amount from the eligibility message from the payer.
9. To add another copay amount:
1. Click the Add another copay amount link.
   Another copay field appears.
2. Select the copay type from the menu and enter the copay amount.

Note: athenahealth recommends that you update patient insurance policies to include up-to-date insurance copay types and amounts.

 

10. Coinsurance percentage — Enter the coinsurance percentage. This value appears on the Check-in and Checkout pages when you collect patient payments.
    Note: If your practice has the payer's allowable schedule in athenaOne and the procedure code is included in the allowable schedule, the expected coinsurance amount is 20% of the allowable.
    If the payer's allowable schedule is not in athenaOne (or if the allowable schedule lacks the procedure code), the expected coinsurance amount is 20% of the charge amount from the fee schedule.
11. Referring provider — Click Choose/view, then search for and select the provider who referred the patient. This provider will be the default referring provider on all claims.
    Note: If you add or update a referring provider to a patient's insurance, you can update all existing appointments and admissions associated with that insurance.
12. Primary care provider — Click Choose/view, then search for and select the patient's primary care physician.
13. Default Medicare secondary qualifier — This field appears only when you add a Medicare policy. The menu provides reasons why Medicare is the secondary payer (if applicable). The resulting code is included on the claim that goes to Medicare, so that the claim is paid correctly. This information may be needed when submitting Medicare Secondary Payer (MSP) claims. For more information, see the Medicare as a Secondary Payer Questionnaire page.
    
14. Notes — Enter any notes about this policy for this patient. You can use this field to record deductible information, the customer service phone number, and other relevant information.

Policy Holder

15. Entity type — Select the policy holder's entity type.
16. Policy holder ID/certification number — If the Patient's relationship to policy holder is set to "Self," this field auto-populates with the number in the Member ID/certification number field.
    If the Patient's relationship to policy holder is not "Self," enter the policy holder's policy ID number.
17. Last name — Enter the policy holder's last name if the policy holder is a person. Enter the name of the entity if the policy holder is not a person.
18. First name — Enter the policy holder's first name if the policy holder is a person. Leave blank for non-person entity.
19. Middle name, suffix — Enter the policy holder's middle name and name suffix if any). Leave blank for non-person entity.
20. Address — Enter the first line of the policy holder's address.
21. Address (ctd) — Enter the second line of the policy holder's address (if needed).
22. ZIP — Enter the policy holder's 5-digit ZIP code. After you enter the ZIP code, the city and state are auto-populated from the athenahealth ZIP code database.
23. Country — Enter the policy holder's country. (This field appears only if your practice has the "Foreign Patient Addresses" feature enabled.)
24. SSN — Enter the policy holder's Social Security number.
    Note: Practice staff registering patients for the first time or editing registration information can enter or re-enter SSN numbers. To see the full Social Security number after it is entered, you must have the Display Full SSN user permission.
25. DOB — Enter the policy holder's date of birth.
26. Sex — Select the policy-holder's gender. If the policy-holder is a non-person entity, select the patient's gender. This field is labeled Patient Sex if the policy-holder is a non-person entity.
27. Employer — Click the Choose link to access the Employer Lookup tool and select the name of the policy holder's employer (or school, if the policy holder is a student). This name is printed in CMS-1500 field 11, labeled "Employer's name or school name."
    Note: If the patient's registration information includes an employer, and if the patient's relationship to insured is SELF, the Employer field defaults to the value in the Patient Registration Employer field. If you select an alternate employer here, athenaOne does not automatically update the patient's registration information.
    
28. Click Add Policy or Add Policy & Perform Eligibility Check.
    You may get a message box saying: "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 click No to return to the Quickview. The policy and eligibility status message appear on the Quickview page under the "Insurances" section.