Patient Entry - Insurance Policy Holder Area Prompts

Tip:  To see more information about a field, click the hyperlink for that field.

Last Name

Displays the patient's name as the default value for the policy holder's Last Name.

Entry options:

• If the patient is the policy holder, press [TAB] to accept.

• Or, to specify a different policy holder, enter a valid patient Account Number or the Last Name. (up to 20 characters)

• Or, to assign the guarantor as the policy holder for this patient, enter G.

• Or, to assign the employer as the policy holder (for workers' compensation), enter E.  This will generate a statement and/or a HCFA claim form for the employer.
  Notes:  

• If you enter E you must enter Employer information at the Patient Entry - Demographics Window.

• If the Insurance Form Type is O the employer receives a private statement.

• If the Insurance Form Type is 1-9 the employer name and address prints as the Insured's name and address on the HCFA claim form.

• If the Insurance Form Type is 1-9, the Insurance Accept Assignment Option is N(o) and the Insurance Responsibility Code is I(nsurance), the employer receives a statement and a HCFA claim form prints.

Notes:

• To search for the patient account number to assign as the policy holder, click Search to the right of the policy holder Last Name.

• To launch the Patient Policy Holder Wizard, click Wizard to the right of the policy holder Last Name.

• The Policy Holder name and address prints on the HCFA claim form.

• If the patient's Last Name was accepted as the policy holder's Last Name, the policy holder's First Name can not be edited.

First Name, I

Displays the patient's First Name as the default value for the policy holder.  Press [TAB] to accept or enter the First Name. (up to 18 characters)

Note:  If the patient's Last Name was accepted as the Policy Holder's Last Name, this field can not be edited.

Relationship

Defaults to the Relationship ID assigned when entering the patient's guarantor information.  Press [TAB] to accept or enter another valid Relationship ID describing the relationship of the patient to the policy holder. (up to 4 characters)

Certificate Number

Enter the policy holder's Insurance Certificate Number. (up to 18 characters)

Notes:

• Displays the guarantor's Certificate Number as the default value.

• Enter ss or SS to quickly fill in the patient's social security number as the policy holder's Insurance Certificate Number.

Group Number

Enter the policy holder's Group Number, if applicable. (up to 15 characters)

Member Number

Enter the policy holder's Member Number, if applicable. (up to 5 characters)

Effective Date

Enter the insurance policy holder's Effective Date, if applicable. [mm/dd/yyyy, slashes (/) not necessary]

Termination Date

Enter the insurance policy's Termination Date, if applicable. [mm/dd/yyyy, slashes (/) not necessary]

Images

To remove or add images, such as scanned insurance ID cards or the patient's photo ID, refer to the options on the Images Menu.

Note:  You can add other images at the Patient Entry - Insurance Window.

Address Area

Note:  You can also maintain the following fields at the Demographics Window.

Address 1

Enter the first line of the patient's mailing address. (up to 25 characters)

Address 2

Enter the second line of the patient's mailing address, if applicable. (up to 25 characters)

City

Enter the city name, town name or a valid City Code (to fill in the associated City, State and Zip Code for this patient). (up to 15 characters)
Required

Notes:  

• To search for a City Code, click Search or press [CTRL + f].

• To create a new City Code, click Fast Maintenance or press [CTRL + o].

State

The US Postal Service State Code displays if you entered a City Code above.  Otherwise, enter the US Postal Service state code for this city. (2 characters)
Required

Zip

The Zip Code displays if you entered a City Code above.  Otherwise, enter the five-digit Zip Code or the nine-digit Zip+4 Code. (up to 10 characters)
Required

D.O.B

Enter the patient's Date of Birth. (mmddyyyy)
Required

Sex

To fill in the patient's Sex Code, click a choice from the drop-down list.
Required

Social Security #

Displays the patient's Social Security Number.

Employer

Enter a predefined Employer ID or the Employer Name.  If you enter an Employer ID, the Employer Name, Address, City, State and Zip Code fill in and can not be edited.  The Employer phone number and extension display and can be edited. (up to 25 characters, or defined during Employer/Lawyer Maintenance)

Notes:

• If billing the employer, such as in the case of a workers' compensation injury or illness, this field is required.

• To search for an Employer ID, click Search or press [CTRL + f].

• To create a new Employer ID, click Fast Maintenance or press [CTRL + o].

Employer Name

If you entered an Employer ID, the Employer Name displays for your reference.

Address

If entering Employer information manually, enter their mailing address. (up to 25 characters)

City

If entering Employer information manually, enter the city name or enter a predefined City Code. (up to 15 characters)

Notes:

• To search for a City Code, click Search or press [CTRL + f].

• To create a new City Code, click Fast Maintenance or press [CTRL + o].

State

If entering Employer information manually, enter the US Postal State Code for this Employer. (2 characters, all caps)

Zip

If entering Employer information manually, enter the five-digit Zip Code or the nine-digit Zip+4 Code for this Employer. [up to 10 characters, dashes not (-) necessary]

Phone Number

The Employer Phone Number displays if an Employer ID was entered above, but it may be edited. (up to 10 characters)

Ext

Enter the phone number extension of the contact person for this Employer, if applicable. (up to 4 characters)