Intracare Implementation Log Episode 34: Entering Insurance Information?

[Ignacio Valdes]

Is there a guide for setting up and entering a patients insurance
infromation? -- IV

[chappyware]

Look at the Vista Documentation for Integrated Billing. I was playing
with a Delphi app to setup insurance company in file 36 only to find
that one is strongly advised not to use Fileman to enter this data as
it affects other parts of the system. Make sure you give yourself the
IB SUPERVISOR key and go to option ^INSURANCE to get to the correct
place.

[David Whitten]

Which option is the correct one that you are talking about?
when you type ^INSURANCE, MenuMan just looks in the options
that are accessible for the current person. It also looks at only
the "MENU TEXT" to match what you type. Unfortunately we don't
have access to your system to find out which one you mean.

David

This is what I found on a WorldVistA EHR system:

VAH>D P^DI
VA FileMan 22.0
Select OPTION: INQUIRE TO FILE ENTRIES
 OUTPUT FROM WHAT FILE: HOSPITAL LOCATION// 19  OPTION  (9686 entries)
Select OPTION NAME: INSURANCE
     1   INSURANCE BUFFER ACTIVITY  IBCN OUTPUT INS BUFF ACTIVITY     Insurance
Buffer Activity
     2   INSURANCE BUFFER EMPLOYEE  IBCN OUTPUT INS BUFF EMPLOYEE     Insurance
Buffer Employee
     3   INSURANCE COMPANY EDI PARAMETE  IBCN INSURANCE EDI REPORT     Insurance
 Company EDI Parameter Report
     4   INSURANCE COMPANY ENTRY/EDIT  DG INSURANCE COMPANY EDIT     Insurance Company Entry/Edit
     5   INSURANCE COMPANY ENTRY/EDIT  IBCN INSURANCE CO EDIT     Insurance Company Entry/Edit
Press <RETURN> to see more, '^' to exit this list, OR
CHOOSE 1-5:
     6   INSURANCE LIST OF UNKNOWNS FOR  DG INSURANCE LIST     Insurance List of UNKNOWNs for Inpatients
     7   INSURANCE PAYMENT TREND REPORT  IB OUTPUT TREND REPORT     Insurance Payment Trend Report
     8   INSURANCE POLICIES NOT VERIFIE  IBJD INTAKE POL NOT VER     Insurance Policies Not Verified
     9   INSURANCE REVIEW EDIT  IBT EDIT COMMUNICATIONS     Insurance Review Edit
     10  INSURANCE UPLOAD  IVM UPLOAD INS     Insurance Upload
CHOOSE 1-10:

Select OPTION NAME:

[chappyware]

INSURANCE COMPANY ENTRY/EDIT IBCN INSURANCE CO EDIT is the best
starting point

[I, Valdes]

Here's my first venture into adding an insurance company:

Setting up programmer environment
This is a TEST account.

Terminal Type set to: C-VT100

Select OPTION NAME: Insurance

1 INSURANCE BUFFER ACTIVITY IBCN OUTPUT INS BUFF ACTIVITY
Insurance
Buffer Activity
2 INSURANCE BUFFER EMPLOYEE IBCN OUTPUT INS BUFF EMPLOYEE
Insurance
Buffer Employee
3 INSURANCE COMPANY EDI PARAMETE IBCN INSURANCE EDI REPORT
Insurance
Company EDI Parameter Report
4 INSURANCE COMPANY ENTRY/EDIT DG INSURANCE COMPANY EDIT
Insurance C
ompany Entry/Edit
5 INSURANCE COMPANY ENTRY/EDIT IBCN INSURANCE CO EDIT
Insurance Comp
any Entry/Edit
Press <RETURN> to see more, '^' to exit this list, OR

CHOOSE 1-5: 5 IBCN INSURANCE CO EDIT Insurance Company Entry/Edit
Insurance Company Entry/Edit
Select INSURANCE COMPANY NAME: ?
You may enter a new INSURANCE COMPANY, if you wish
ANSWER MUST BE 3-30 CHARACTERS IN LENGTH

Select INSURANCE COMPANY NAME: Amerigroup
Are you adding 'Amerigroup' as a new INSURANCE COMPANY? No// Y
(Yes)
INSURANCE COMPANY STREET ADDRESS [LINE 1]: ??
Enter the first line of this company's street address with 3-35
characters.
INSURANCE COMPANY STREET ADDRESS [LINE 1]: 4425 Corporation Lane
INSURANCE COMPANY STREET ADDRESS [LINE 2]:
INSURANCE COMPANY STREET ADDRESS [LINE 3]:
INSURANCE COMPANY CITY: Virginia Beach
INSURANCE COMPANY STATE: VA VIRGINIA
INSURANCE COMPANY ZIP CODE: 23462
INSURANCE COMPANY REIMBURSE?: ?
Choose from:
Y WILL REIMBURSE
* WILL REIMBURSE IF TREATED UNDER VAR 6046(C) OR VAR
6060.2(A)
** DEPENDS ON POLICY, CHECK WITH COMPANY
N WILL NOT REIMBURSE
INSURANCE COMPANY REIMBURSE?: Y WILL
REIMBURSE.....................
Insurance Company Editor Dec 05, 2008@16:31:06 Page:
8 of 8
Insurance Company Information for: Amerigroup
Type of Company: Currently Active
+
Remarks

Synonyms









Enter ?? for more
actions >>>
BP Billing Parameters IO Inquiry Office EA Edit All
MM Main Mailing Address AC Associate Companies AI (In)Activate
Company
IC Inpt Claims Office ID Prov IDs/ID Param CC Change
Insurance Co.
OC Opt Claims Office PA Payer DC Delete Company
PC Prescr Claims Of RE Remarks VP View Plans
AO Appeals Office SY Synonyms EX Exit
Select Action: Quit// QUIT

[I, Valdes]

Here is another foray, adding insurance information to ZZPatient, Test
One:

Select OPTION NAME: patient insurance
1 PATIENT INSURANCE INFO VIEW/ED IBCN PATIENT INSURANCE
Patient Insu
rance Info View/Edit
2 PATIENT INSURANCE MENU IBCN INSURANCE MGMT MENU Patient
Insurance
Menu
CHOOSE 1-2: 2 IBCN INSURANCE MGMT MENU Patient Insurance Menu


PI Patient Insurance Info View/Edit
VP View Patient Insurance
EI Insurance Company Entry/Edit
VI View Insurance Company
EPR Insurance Company EDI Parameter Report
BI Process Insurance Buffer
EPH e-Pharmacy Menu ...
IIV IIV Menu ...
LC List Inactive Ins. Co. Covering Patients
LP List Plans by Insurance Company
MI Medicare Insurance Intake
MV Move Subscribers to a Different Plan
NC Verification of No Coverage Report
NE Active Policies with no Effective Date Report
NV List New not Verified Policies
RQI Remote Insurance Query
WO Patients with or without Insurance Report

Select Patient Insurance Menu Option: BI Process Insurance Buffer
Insurance Buffer List Dec 05, 2008@16:35:05 Page:
1 of 1
Buffer File entries not yet processed. (sorted by Patient Name)
Patient Name Insurance Company Subscr Id Src
Entered iIEYH

There are no Buffer entries that have not been processed.

Enter ?? for more actions

Process Entry EE Expand Entry Sort List X Exit
(Reject Entry) Add Entry Check Ins Co's
Select Action: Quit// Add Add Entry
Select PATIENT NAME: ZZ
1 ZZ PATIENT,TEST ONE <A> F 01-24-1945
000003322 1
2 ZZ PATIENT,TEST THREE <CA> M
01-15-1968 3
3 ZZ PATIENT,TEST TWO <A> M
12-25-1957 2
4 ZZFAKE,PATIENT F 01-18-2000 111188541

111188541
5 ZZFAKE,PATIENT M 03-24-2000 111101008

111101008
ENTER '^' TO STOP, OR
CHOOSE 1-5: 1
ZZ PATIENT,TEST ONE <A> F 01-24-1945
000003322 1

***WARNING***
***RESTRICTED RECORD***


***WARNING***
***RESTRICTED RECORD***


Insurance Company: ?

Please enter the name of the insurance company that provides coverage
for this
patient. This response is a free text response, however, a partial
insurance
company name look-up is available here.

Insurance Company: Amerigrou

Add a new Insurance Buffer entry for this patient and company? YES//

------------------------ INSURANCE COMPANY INFORMATION
-------------------------

INSURANCE COMPANY NAME: AMERIGROU// AMERIGROUP
REIMBURSE?: ?
Does this company reimburse the VA for care provided to it's
policy
holders?

Choose from:
Y WILL REIMBURSE
* WILL REIMBURSE IF TREATED UNDER VAR 6046(C) OR VAR
6060.2(A)
** DEPENDS ON POLICY, CHECK WITH COMPANY
N WILL NOT REIMBURSE

REIMBURSE?: Y WILL REIMBURSE
PHONE NUMBER:
BILLING PHONE NUMBER:
PRECERTIFICATION PHONE NUMBER:
STREET ADDRESS [LINE 1]:
CITY:
STATE:
ZIP CODE:

---------------------------- GROUP/PLAN INFORMATION
----------------------------
The following data defines a specific Group or Plan provided by an
Insurance
Company. This may be either a group plan with many potential members
or an
individual plan with a single member.

IS THIS A GROUP POLICY?:
GROUP NAME:
GROUP NUMBER:
BANKING IDENTIFICATION NUMBER:
PROCESSOR CONTROL NUMBER (PCN):
TYPE OF PLAN:
UTILITZATION REVIEW REQUIRED:
PRECERTIFICATION REQUIRED:
AMBULATORY CARE CERTIFICATION:
EXCLUDE PREEXISTING CONDITION:
BENEFITS ASSIGNABLE:

---------------------- POLICY AND SUBSCRIBER INFORMATION
-----------------------
The following data defines the subscriber specific policy information
for a
particular Insurance Plan. The subscriber, the insured, and the
policy holder
all refer to the person who is a member of the plan and therefore
holds the
policy. The patient must be covered under the plan but may not be
the policy
holder.

EFFECTIVE DATE:
EXPIRATION DATE:
WHOSE INSURANCE:
PT. RELATIONSHIP TO INSURED:
SUBSCRIBER ID:
NAME OF INSURED:
INSURED'S DOB:
INSURED'S SSN:
INSURED'S SEX:
PRIMARY CARE PROVIDER:
PRIMARY PROVIDER PHONE:
COORDINATION OF BENEFITS:
SOURCE OF INFORMATION: INTERVIEW//
ESGHP?: |
Insurance Buffer List Dec 05, 2008@16:36:33 Page:
1 of 1
Buffer File entries not yet processed. (sorted by Patient Name)
Patient Name Insurance Company Subscr Id Src
Entered iIEYH
1 !ZZ PATIENT,TEST 3322 AMERIGROUP INTVW
12/05/08

Enter ?? for more actions

Process Entry EE Expand Entry Sort List X Exit
(Reject Entry) Add Entry Check Ins Co's
Select Action: Quit// QUIT



PI Patient Insurance Info View/Edit
VP View Patient Insurance
EI Insurance Company Entry/Edit
VI View Insurance Company
EPR Insurance Company EDI Parameter Report
BI Process Insurance Buffer
EPH e-Pharmacy Menu ...
IIV IIV Menu ...
LC List Inactive Ins. Co. Covering Patients
LP List Plans by Insurance Company
MI Medicare Insurance Intake
MV Move Subscribers to a Different Plan
NC Verification of No Coverage Report
NE Active Policies with no Effective Date Report
NV List New not Verified Policies
RQI Remote Insurance Query
WO Patients with or without Insurance Report

Select Patient Insurance Menu Option:

Do you really want to halt? YES//

[I, Valdes]

So if the insurance information on a particular patient is entered,
can it be seen via CPRS? I've looked around in CPRS for this on
patient ZZTest, Patient One that I just entered the insurance info on
but so far do not see it. -- IV

[Nancy Anthracite]

Did you double click on the demographics part which is where the patient's
name is in the upper left hand corner of the cover sheet (and probably the
other sheets as well)?

--
Nancy Anthracite

[I, Valdes]

Ah! That pops up the following which doesn't seem to list the
insurance company name although it notes that it has 'Insurance
Buffer' entries which sounds like some kind of medication :-) This
looks very useful though.

Health Insurance Information:
Insurance COB Subscriber ID Group Holder Effective
Expires

===========================================================================
No Insurance Information

*** Patient has Insurance Buffer entries ***

Can custom fields be added to this whole page that pops up?

-- IV

[Nancy Anthracite]

I don't know how, yet, but I am sure we can program it in, and frankly, I have
been eyeing that for some of the CCHIT requirements, so that might not be a
bad idea to put in there, too.

--
Nancy Anthracite

[chappyware]

CPRS has a button that lights up blue when a pt is insured.It pops up
a box with insurance information. I notice worldvista CPRS lacks this
button. This was introduced in version 26 so its been around for at
least a year.

> Nancy Anthracite- Hide quoted text -
>
> - Show quoted text -

[I, Valdes]

So CPRS 27 would have this, I wonder if that is coming along? -- IV

[chappyware]

V27 has a number of unresolved issues. I would not rush to that
version.

[Nancy Anthracite]

I have been hearing about the problems as well and am concerned about moving
to it right away.

It is a moot point anyway since we don't have it, and I suspect because of the
problems, it may not be released right away.

--
Nancy Anthracite

[chappyware]

I stand corrected on the insurance button. It only appears IF THE PT
HAS INSURANCE. I've not gotten that far but if someone has assigned a
pt to an insurance company correctly, the insurance button should
appear next to the patient record flag panel.

[I, Valdes]

So I have the patients 'insurance buffer' um, titrated :-) How then do
I confirm to the system that ZZPatient, Test One has Fine Print
Insurance Group, Inc such that all the bells and whistles go off and
it appears in CPRS?

-- IV

[chappyware]

I've not had time to do it but first set up the insurance company.
Then Register a pt. The insurance info goes into a temporary buffer
waiting for someone to process it--don't know the key you need for
that but it should be in the documentation. Once the pt is registered
with insurance, I suspect the Insurance panel will show up on the
coversheet.

[chappyware]

look at page 154 of the Integrated Billing User Manual. I think you'll
find some answers there.

[chappyware]

I got the insurance panel to appear in CPRS. Its a multi-step process
but here's some of the menu activity

PI Patient Insurance Info View/Edit

VP View Patient Insurance

EI Insurance Company Entry/Edit

VI View Insurance Company

EPR Insurance Company EDI Parameter Report

BI Process Insurance Buffer

EPH e-Pharmacy Menu ...

IIV IIV Menu ...

LC List Inactive Ins. Co. Covering Patients

LP List Plans by Insurance Company

MI Medicare Insurance Intake

MV Move Subscribers to a Different Plan

NC Verification of No Coverage Report

NE Active Policies with no Effective Date Report

NV List New not Verified Policies

PM Payer Maintenance Menu ...

RQI Remote Insurance Query

WO Patients with or without Insurance Report

Select Patient Insurance Menu Option: pi Patient Insurance Info View/
Edit



Select PATIENT NAME:

PUG,DUDLEY M 07-28-2007 000000014


000000014









AB Annual Benefits RI Personal Riders EX Exit



Patient Insurance Management Dec 08, 2008@13:52:21 Page:
1 of 1

Insurance Management for Patient: PUG,DUDLEY P0014

*** Patient has Insurance Buffer Records

Insurance Co. Type of Policy Group Holder Effect.
Expires



No Insurance Policies on file for this
patient.

Enter ?? for more
actions >>>

AP Add Policy EA Fast Edit All CP Change Patient

VP Policy Edit/View BU Benefits Used WP Worksheet
Print

DP Delete Policy VC Verify Coverage PC Print
Insurance Cov.

AB Annual Benefits RI Personal Riders EX Exit

Select Item(s): Quit// ap Add Policy



The way we store and think about patient insurance information has
been

dramatically changed. We are separating out information that is
specific

to an insurance company, specific to the patient, specific to the
group plan,

specific to the annual benefits available, and the annual benefits
already

used.



To start, you must select the insurance company for the patient's
policy.



Select INSURANCE COMPANY: Aetna 123 MAIN Y



Each Insurance policy entry for a patient must be associated with an

Insurance Plan offered by the Insurance company you just selected.

You will be given a choice of selecting previously entered Group Plans
or

you may enter a new one. If you enter a new Insurance Plan you

must enter whether or not this is a group or individual plan.





This company does not offer any active group plans.

Do you wish to add a new Insurance Plan? NO// y YES

IS THIS A GROUP PLAN: y YES

GROUP PLAN NAME: STANDARD

GROUP PLAN NUMBER: 12345



Searching for potential duplicate plans offered by AETNA...



No potential duplicate plans have been identified.



Now you may enter the patient specific policy information.

Most of these fields will be familiar to experienced users. The field

'SUBSCRIBER ID' used to be called 'INSURANCE NUMBER' and

has been modified to allow entering just 'SS' to retrieve

the patients SSN. This field is the identifier for the policy or
patient

that the carrier uses. See the new help.



EFFECTIVE DATE OF POLICY: 1/1/08 (JAN 01, 2008)

INSURANCE EXPIRATION DATE: 1/1/10 (JAN 01, 2010)



WARNING: The expiration date for this policy is in the future!

Normally this is a past date or left blank or a past date



INSURANCE EXPIRATION DATE: JAN 1,2010//

WHOSE INSURANCE: p??

Choose from:

v VETERAN

s SPOUSE

o OTHER

WHOSE INSURANCE: v VETERAN

SUBSCRIBER ID: 12345

INSURED'S DOB: 7/28/07 (JUL 28, 2007)

INSURED'S SEX: m MALE

SOURCE OF INFORMATION: INTERVIEW//

COORDINATION OF BENEFITS:

PRIMARY CARE PROVIDER:

PRIMARY PROVIDER PHONE:

WARNING: The expiration date for this policy is in the future!

Normally this is a past date or left blank or a past date





You can now edit information specific to the PLAN. Remember, updating

PLAN information will affect all patients with this plan, if it is a

group plan, and not just the current patient.



GROUP NAME: STANDARD//

GROUP NUMBER: 12345//

BANKING IDENTIFICATION NUMBER:

PROCESSOR CONTROL NUMBER (PCN):

TYPE OF PLAN: ?

Enter the type of policy that best describes this policy.

Active Types of Plans Only!

Answer with TYPE OF PLAN NAME, or ABBREVIATION, or MAJOR CATEGORY

Do you want the entire TYPE OF PLAN List? y (Yes)

Choose from:

ACCIDENT AND HEALTH INSURANCE MAJOR MEDICAL

AUTOMOBILE MAJOR MEDICAL

CARVE-OUT MAJOR MEDICAL

CATASTROPHIC INSURANCE MAJOR MEDICAL

CHAMPVA MAJOR MEDICAL

COMPREHENSIVE MAJOR MEDICAL MAJOR MEDICAL

DENTAL INSURANCE DENTAL

HEALTH MAINTENANCE ORGANIZ MAJOR MEDICAL

INCOME PROTECTION (INDEMNITY) INDEMNITY

INDIVIDUAL PRACTICE ASSOCATION MAJOR MEDICAL

INPATIENT (BASIC HOSPITAL) MAJOR MEDICAL

LABS, PROCEDURES, X-RAY, ETC. ALL OTHER

MANAGED CARE SYSTEM (MCS) MAJOR MEDICAL

MEDI-CAL MEDICAIDE

MEDICAID MEDICAIDE

MEDICAL EXPENSE (OPT/PROF) MAJOR MEDICAL

MEDICARE (M) MEDICARE

MEDICARE SECONDARY MAJOR MEDICAL

MEDICARE/MEDICAID (MEDI-CAL) MEDICARE

MEDIGAP (SUPPLEMENTAL) MEDICARE SUPPLEMENTAL

MENTAL HEALTH ALL OTHER

NO-FAULT INSURANCE MAJOR MEDICAL

POINT OF SERVICE HMO

PREFERRED PROVIDER ORGANIZATIO PPO

PREPAID GROUP PRACTICE PLAN HMO

PRESCRIPTION PRESCRIPTION

RETIREE MAJOR MEDICAL

SPECIAL CLASS INSURANCE MAJOR MEDICAL

SPECIAL RISK INSURANCE MAJOR MEDICAL

SPECIFIED DISEASE INSURANCE MAJOR MEDICAL

SURGICAL EXPENSE INSURANCE MAJOR MEDICAL

TORT FEASOR ALL OTHER

TRICARE CHAMPUS

TRICARE SUPPLEMENTAL MAJOR MEDICAL

WORKERS' COMPENSATION INSURANC WORKMANS COMP



TYPE OF PLAN: comPREHENSIVE MAJOR MEDICAL MAJOR MEDICAL

ELECTRONIC PLAN TYPE:

PLAN FILING TIME FRAME:

IS UTILIZATION REVIEW REQUIRED:

AMBULATORY CARE CERTIFICATION:

IS PRE-CERTIFICATION REQUIRED?: n NO

EXCLUDE PRE-EXISTING CONDITION: n NO

BENEFITS ASSIGNABLE?: YES// YES



COVERED BY HEALTH INSURANCE changed to 'YES'.

.









AB Annual Benefits RI Personal Riders EX Exit



Patient Insurance Management Dec 08, 2008@13:54:13 Page:
1 of 1
Insurance Management for Patient: PUG,DUDLEY P0014
*** Patient has Insurance Buffer Records
Insurance Co. Type of Policy Group Holder Effect.
Expires
1 AETNA COMPREHENSIVE M 12345 SELF 01/01/08
01/01/10

Enter ?? for more
actions >>>

AP Add Policy EA Fast Edit All CP Change Patient
VP Policy Edit/View BU Benefits Used WP Worksheet
Print
DP Delete Policy VC Verify Coverage PC Print
Insurance Cov.
AB Annual Benefits RI Personal Riders EX Exit
Select Item(s): Quit//

[ival...@gmail.com]

Hmm, which manual are we talking about? This page has several:

http://www.va.gov/vdl/search.asp?group=document&terms=Integrated+billing+manual

[I, Valdes]

Thanks, this worked and it now shows up on the patient 'Patient
Inquiry' display. I have put this on the Clerk menu now using the
Intracare Implementation Log Episode 29: Adding Appointment Schedule
Menu to Clerk ID example.
http://groups.google.com/group/Hardhats/browse_frm/thread/2fd72547249366ee/dc3ea0876a5712d6?lnk=gst&q=Intracare+menu+schedule#dc3ea0876a5712d6

-- IV

On Dec 8, 12:58 pm, chappyware <chappywa...@verizon.net> wrote:
> I got the insurance panel to appear in CPRS. Its a multi-step process
> but here's some of the menu activity
>
>    PI     Patient Insurance Info View/Edit
>
>    VP     View Patient Insurance
>
>    EI     Insurance Company Entry/Edit
>
>    VI     View Insurance Company
>
>    EPR    Insurance Company EDI Parameter Report
>
>    BI     Process Insurance Buffer
>
>    EPH    e-Pharmacy Menu ...
>
>    IIV    IIV Menu ...
>

>    LC     List InactiveIns. Co. Covering Patients

> ...
>
> read more »