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Patient Insurance

I. PRINCIPLE:

The Patient Insurance screen provides access for manually modifying patient insurance information in the Laboratory Information System (LIS) either by changing existing information or adding new information.

II. PROCEDURE:

  1. Open Patient Insurance:
    Click on the Patient Insurance button located on the Lab Palette or choose “Patient Insurance” from the Screens drop-down menu on the menu bar.
      
  2. Patient Search:
    1. Patient search using ID number:
      1. Type in the patient’s unique ID number into the Patient ID field and press ENTER.
      2. If information exists in the LIS database under this number, it will fill the "Patient Insurance" screen. If no patient is found, a message displays telling the operator to check the search criteria and try again, click [OK] to return to the refreshed patient search screen.
    2. Patient search by name:
      1. TAB to the Last Name field and type in the patient's last name (for common last names also type in the first name and date of birth to further restrict the search) then press ENTER. If no patient is found, a message displays telling the operator to check the search criteria and try again, click [OK] to return to the refreshed patient search screen.
        Note: If the correct spelling of the patient's last name is in question, type in only the first few letters. Example Schmidt vs. Schmit or Schmitt; type in only “Schmi” to display all.
      2. A listing of all patients in the LIS database who match the search criteria will display.
        Note: If the same patient is listed, inappropriately, under more than one ID number, print the screen. Highlight the names, indicate that the patient records are possible candidates for merge and send the screen print to the LIS Project Coordinator.
      3. Select the desired patient. Using the mouse, double-click on the correct patient name. The scroll window will disappear and the selected patient insurance information will fill the Patient Insurance screen.
        Note: If the wrong patient is selected, return to the list of names based on the search criteria entered by, clicking Function on the menu bar and selecting “Last Name Search” from the drop-down menu.
  3. Existing Patient Insurance Information:
    1. If insurance information was previously entered and saved it will be displayed. If no information is displayed proceed to step 4.
    2. Review the information found in the patient insurance record.
      1. If incorrect insurance information is displayed (i.e.: provider, group, ID #, etc…) go to the appropriate field using the TAB key or the mouse.
      2. Type in the correct information.
      3. Save the modifications by pressing the Ctrl+s keys.
        Note: If insurance information has been added or modified and a save has not been performed, a window will appear which will ask "Do you wish to Save the changes before continuing?". Either press the ENTER key to select Yes (the default answer) or using the mouse, click once on the [Yes], [No] or [Cancel] buttons
        .
      4. Review the insurance card scanned image via the display card list. If the card has not been scanned within the last 30 days or the insurance has changed since the last scan the card(s) should be scanned.
        Note: Be sure to have the insurance information displayed on the screen for the card being scanned.
        1. Click on the [Scan/View Card] button to view the list of scanned images or to scan a card. The saved images will display chronologically most recent first.
        2. Click on the desired listing to be reviewed, most likely the top listing.
          Note: An hourglass image will appear indicating the images are being retrieved.
        3. If the information on the patient insurance card is the same there is no need to scan the card again.
        4. If it is necessary to scan the card click on the “scan card” tab.
        5. The Select Source screen will display.
        6. Highlight DS687 3.4 (32-32), if not already highlighted, and click on the [Select] button. The following screen will display.
        7. Insert the insurance card in the scanner (it will make a low tone beep when it senses the card) and then click on the [OK] button to initiate the scan.
        8. The insurance card scanned image will display. If acceptable, click the [Save] button. If rescanning is necessary click the [Scan] button again and rescan the card and then [Save].
  4. Add Insurance Information:
    If no insurance information is saved on the patient ID entered a blank insurance information fields will display:

    Note: Click on the [Add] button in the insurance information section to add additional blank fields for secondary, tertiary, etc., insurance information. In the reverse, to delete an insurance already entered for a patient, select the desired insurance to delete and then click on the [Delete] button.
    1. Guarantor Information:
      Guarantor is defined for our system as the patient unless the patient is less than 18 years of age. If the patient is less than 18 years of age the parent or guardian of the patient that carries the insurance policy is the guarantor (the person with financial responsibility for the patient).
      Note: Click on the [Delete] button to delete existing Guarantor information.
      1. Relation to Patient: Select the appropriate description from the list (Self, Dependent, Spouse or Other).
        Note: If “Self” selected, all guarantor information will auto-fill from the patient’s saved demographic record.
      2. SSN: Social security number of the guarantor
      3. Last/First/ Middle: Name of the guarantor.
      4. Date of Birth/Sex: Type in the numbers only representing month, day and year; the slashes are embedded. Tab to the Sex field and type: m for male, f for female or u for unknown.
      5. Home/Work: Type in appropriate phone numbers for the guarantor.
      6. Address 1: Type in any contributing address information (Apt #, Lot #, etc.).
        Note: If the patient has both a street address and a PO Box, the street address is entered in this line.
      7. Address 2: Type in the deliverable street address.
        Note: If the patient has both a street address and a PO Box, the PO Box is always the deliverable address and is entered in this line.
      8. Zip: Type in the Zip code. If the code is 9 digits do not enter the dash (-).
        Note: A Postal or Zip Code table has been added to the database.

        When a Zip code is typed in and is recognized the City, State and Country fields will automatically fill after tabbing from the field. If the Zip code entered is not recognized the option is given to register a new zip code, a message appears “Postal code not on file, do you want to enter a new location?”, with options [Yes] to enter a new zip code or [No] to return to the screen. Before attempting to register a new zip code check to make sure the number entered is correct by clicking and dragging the message so that the zip code entered is in view. If the number is correct click [Yes] to register the new number, if the zip code entered in incorrect, click [No] to return to the field and correct the number entered.
      9. Save the information entered by pressing the Ctrl+s keys. The date, time and user Id of the person adding or updating Guarantor information will display.
    2. Guardian Information:
      The guardian is the person that is legally responsible for the patient if the patient is a dependent due to age or other circumstances. This person is not necessarily the same person listed as Guarantor (financial responsibility).
      Note: Complete the “Guardian” information on all children having a blood lead performed. The information is used in the letter that prints with the patient’s cumulative report and sent to the patient’s guardian regarding the test results.
      Note: Click on the [Delete] button to delete existing Guardian information.
      1. Relation to Patient: Select the appropriate description from the list (Self, Dependent, Spouse or Other).
        Note: If “Self” is selected, all guarantor information will auto-fill from the patient’s saved demographic record.
      2. SSN: Social security number of the guardian
      3. Last/First/ Middle: Name of the guardian.
      4. Date of Birth/Sex: Type in the numbers only representing month, day and year; the slashes are embedded. Tab to the Sex field and type: m for male, f for female or u for unknown.
      5. Home/Work: Type in appropriate phone numbers for the guardian.
      6. Address 1: Type in any contributing address information (Apt #, Lot #, etc.).
        Note: If the patient has both a street address and a PO Box, the street address is entered in this line.
      7. Address 2: Type in the deliverable street address.
        Note: If the patient has both a street address and a PO Box, the PO Box is always the deliverable address and is entered in this line.
      8. Zip: Type in the Zip code. If the code is 9 digits do not enter the dash (-).
        Note: A Postal or Zip Code table has been added to the database.

        When a Zip code is typed in and is recognized the City, State and Country fields will automatically fill after tabbing from the field. If the Zip code entered is not recognized the option is given to register a new zip code, a message appears “Postal code not on file, do you want to enter a new location?”, with options [Yes] to enter a new zip code or [No] to return to the screen. Before attempting to register a new zip code check to make sure the number entered is correct by clicking and dragging the message so that the zip code entered is in view. If the number is correct click [Yes] to register the new number, if the zip code entered in incorrect, click [No] to return to the field and correct the number entered.
      9. Save the information entered by pressing the Ctrl+s keys. The date, time and user Id of the person adding or updating Guardian information will display.
    3. Rank: (required field)
      TAB to the Rank field and type in p, s or t (primary, secondary or tertiary respectively) to indicate the correct ranking of the insurance being entered and press TAB to go to the Payer field.
      Note: Insurance ranking must be listed in order (i.e.: primary, secondary, tertiary, etc…).
    4. Insurance Company: (required field)
      If the UCL-assigned insurance company code is known, type this code in the field to display the insurance company name. If the assigned code is not known proceed as follows:
      1. Type in the first letter of the insurance provider name to display the first provider name listed beginning with the letter entered.
      2. Open the list by moving the pointer arrow directly over the drop-down menu arrow to the right of the text field and click the left mouse button once. A scroll window will display with defined insurance providers.
      3. Using the up/down arrow keys or the mouse scroll to and select the correct insurance provider name then press TAB to go to the Subscriber # field.
        Note: Some providers may be listed more than once with various mailing addresses (e.g.: Prudential or BC/BS) be sure to select the correct insurance based on ALL the information available. If the desired insurance provider is not in the list, select "(87) Undefined Insurance Provider" and FAX (556-0986) the patient insurance information to the UCL Insurance Dept.
    5. Policy #: (required field)
      Type in the insurance identification number, then press TAB to go to the next field.
    6. Group:
      Type in the number or name of the group, if provided, then press TAB to go to the next field.
    7. Plan/Program:
      If the insurance has a Plan or Program number in addition to the Policy number type the Plan/Program number in, then TAB to go to the next field.
    8. Patient Relation to Subscriber: (required field)
      Using the up/down arrow keys, indicate the correct relationship of the patient to the subscriber (self, spouse, dependent or other). Press TAB to go to the next field.
      Note: If “Self” selected, all subscriber information will auto-fill from the patient’s saved demographic record.
    9. Subscriber’s Social Security Number:
      If the patient is the subscriber (guarantor), use the auto-fill feature. If the subscriber is someone other than the patient type in the subscriber's name exactly as it appears on the insurance card.
    10. Last Name: (required field)
      Type in the Subscriber’s last name, then press TAB to go to the next field.
    11. First Name: (required field)
      Type in the Subscriber’s first name as it appears on the insurance card, then press TAB to go to the next field.
    12. Middle Initial/Name: Type in the Subscriber’s middle initial or name, however it appears on the insurance card. If the middle initial or name is not on the card, leave this field blank. Press TAB to go to the next field.
    13. Sex: (required field)
      Using the up/down arrow keys, indicate the correct sex of the Subscriber (Male or Female). Press TAB to go to the next field.
    14. Birthdate:
      Type in the Subscriber’s date of birth (mmddyyyy), then press TAB to go to the next field.
    15. Employer/School:
      Type in the Subscriber’s employer or school, press TAB to go to the next field.
    16. Employment Status:
      Using the up/down arrow keys, indicate the correct employment status of the Subscriber (Fulltime, Parttime, Fulltime Student, Parttime Student, No or Other). Press TAB to go to the next field.
    17. Address Line 1:
      Type in any contributing address information (Apt #, Lot #, etc.).
      Note: If the patient has both a street address and a PO Box, the street address is entered in this line.
    18. Address Line 2: (required field)
      Type in the Subscriber’s address (line 2 must contain the patient deliverable address, any , press TAB to go to the next field.
      Note: If the patient has both a street address and a PO Box, the PO Box is always the deliverable address and is entered in this line.
    19. Postal (Zip) Code: (required field)
      Type in the postal code. Use only the 5 digit postal code; if the additional 4 digits are given, do not enter them.
      Note: A Postal or Zip Code table has been added to the database.

      When a postal code is typed in and is recognized, the City, State and Country fields will automatically fill after tabbing from the postal code field. If the postal code entered is not recognized the option is given to register a new postal code, a message appears “Postal code not on file, do you want to enter a new location?”, with options [Yes] to enter a new zip code or [No] to return to the screen.
      Warning: Before attempting to register a new postal code check to make sure the number entered is correct by clicking and dragging the message so that the postal code entered is in view. If the number is correct click [Yes] to register the new number, if the postal code entered in incorrect, click [No] to return to the field and correct the number entered.
      Entering a new postal code:

      1. Type in the name of the city, TAB to the next field.
      2. Type in the name of the state and TAB to the code field and type in the appropriate state code (2 digit abbreviation), TAB to the next field.
      3. Type in the country and TAB to the code field and type in the appropriate country code (e.g.: United States: USA, Canada: CAN, etc.).
      4. Click the [OK] button to save the entries. The [Cancel] button will close the “New Postal Code” entry screen without saving the data entered.
    20. Phone:
      Type in the Subscriber’s area code and telephone number.
    21. If a secondary insurance has to be added click on the [Add] button and repeat the process from steps C.a.-s. until all patient insurance providers have been added.
    22. After completing all patient insurance information save the entries to the database by pressing the Ctrl+s keys.
    23. Scan the patient insurance card following the steps outlined in II.3.B.d.
  5. When all patient insurance modifications are complete, exit the Patient Insurance screen by pressing the Ctrl+F4 keys. The screen will return to the previously opened screen.
  6. If patient insurance modifications have not been saved to the database, a message will display asking whether to save the changes made.
    1. If Yes, press ENTER (to select the default choice) or using the mouse, click once on the [Yes] button. The modifications will be saved and the previously opened screen will appear.
    2. If No, using the mouse, click one on the [No] button. The modifications will NOT be saved and the previously opened screen will appear.
    3. To Cancel the command and revert back to the original Patient Insurance screen, click once on the [Cancel] button. Modifications will NOT be saved and additional modifications can be made.
    1. 10-6-97 M. English
    2. March 2001 M. English (Revised: CLICS version; section II.1, 2, 3.C.e-f.)
    3. December 2005 M. English (Revised: for HIPAA compliance)
    4. September 2009 M. English (Revised: II.4.A.d. DOB/Sex, B.d. DOB/Sex, & .D.search by assigned insurance co. code)
    5. October 2010 M. English (Revised: country added to guarantor, guardian & subscriber addresses)
    6. January 2011 M. English (Revised: II.3.B.d.)

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