Green fields are mandatory, you can turn it off at System/Options/Data.
Patient Account # (PAN): An account number is automatically populated (assigned by the software) based on your selections under the "System/Options/Data" section of the Pro Health Billing program.
Edit PAN: You can edit the assigned number by double-clicking in this field and selecting "Yes" when asked if you are sure you want to edit this field.
Edit Last Name: You can edit the last name by double-clicking in this field and selecting "Yes" when asked if you are sure you want to edit this field.
Provider: You can select a default provider. It's only a default, and you can change the provider when adding a claim.
Referring: Select the referring physician. If the referring physician is not in the database, you can add them on the fly by selecting "Add" on the dropdown list.
Insurance or Patient Pay: If Patient pay is selected, the Add insurance button greys out.
Pay Group: This is user definable, and there are a few financial reports you can run by.
Pay and Adj
Adding an Insurance to a Patient
To add an insurance to a patient, follow these steps:
- In the Patient Database, click on the Insurance tab.
- Click on the Add button in the Insurance Section.
- In the Type field, select the type of insurance this is (Primary, Secondary, Tertiary, or Independent). However, you can only enter a Secondary or Tertiary insurance if a Primary insurance already exists.
- Active?: In this area, select Yes if this is an active insurance, or No if this insurance has become inactive. (If you make an insurance inactive, you must put an Expiration Date in the Expiration field). The selection will automatically populate as Yes the first time you enter a Primary Insurance.
- In the Insurance field, select the Insurance Company name from the drop-down menu. If the Insurance Company does not exist on the list, click on the word Add from within that menu to add a new one. This will appear in Box 11c of the HCFA/CMS 1500 Claim Form.
- Fill out the rest of the labeled fields.
- In the Start date field, enter the start date of the insurance coverage as a two-digit month, two-digit day, and four-digit year. This information can be obtained when verifying Patient coverage with their insurance company.
- In the Expiration date field, enter the expiration date of the insurance coverage as a two-digit month, two-digit day, and four-digit year. ONLY enter a plan expiration date when the insurance has ALREADY expired. (This field is required if making an insurance inactive).
- In the Co-Pay field, enter the amount of the co-payment to be collected per visit (no $ sign), or the percentage of the visit to be charged as a co-payment each time the Patient sees you. This information can be obtained when verifying Patient coverage with their insurance company.
- Is the Patient the Subscriber? If the Patient is the subscriber of his or her insurance (the insurance is under their name), click the OK button and follow the same steps above to enter their Secondary and/or Tertiary insurances.
- If the Patient is NOT the subscriber (meaning they are covered by someone else such as their parent or spouse), select No in the Insured Same as Patient option, and then continue with the steps below: a. The Address, City, State, and Zip fields will fill in based on the information provided under the Demographics Tab. If this information is incorrect, make the changes as necessary in these fields. This will appear in Box 7 of the HCFA/ CMS 1500 Claim Form. b. In the Last Name and First Name field, enter the name of the subscriber of the insurance. This information can be obtained when verifying Patient coverage with their insurance company. This will appear in Box 4 of the HCFA/ CMS 1500 Claim Form. c. Sex: Select either (F) for Female, or (M) for Male from the drop-down menu provided in this field to specify the Patient’s gender. This will appear in Box 11a of the HCFA/ CMS 1500 Claim Form. d. D.O.B.: In this field, enter the Subscriber’s Date of Birth as a two-digit month, two-digit day, and four-digit year. This will appear in Box 11a of the HCFA/CMS 1500 Claim Form. e. From the drop-down menu in the Patient Relationship to the Insured
Note: You can add a note in this section. This is for in-house only. For example, if you need to get a copy of the patient's insurance card, you can put a note in there, and on the patient lookup screen, there will be a check mark indicating that there is a note the office must read.
Documents: Here is where you can upload attachments to the patient, such as a copy of the insurance card...
Here you can view, edit closed claim if needed
You can set defaults for when you are filing a claim, it will automatically bring the information to the next claim added
This is where you can set the default diagnosis
For quick reference about the patient past visits. Please refer to Schedules section for more detail
Please refer to the Transportation for more detail