To create a Bill against an Insurance Company, the Billing Preference of the Patient must be set to “Corporate“. When you create a Bill for such a Patient, Clinicea automatically selects the first active Insurance Policy it finds in the Patient’s record (by active, it means a policy that has not expired). If the Patient has multiple policies, you can select the Policy the Patient prefers to use for billing today. From thereon, all rules and limits as covered by the selected Insurance Policy get applied to the bill. Once the bill is ready to be finalized, the Bill total is split into
a. Patient contribution amount and;
b. Insurance due amount.
For example, A Patient subscribes to an Insurance Policy called Start-Up from the Insurance Company called Lloyds. The Policy has a few rules which cover the cost of Consultations and Lab Tests. The Policy also includes a Patient Co-Pay rule, where the Patient must pay 20% or a maximum of $150 in a single bill. There is a 10% discount on Medications and Inventory.
The Patient comes to the Clinic for an Annual Checkup and the Practitioner orders a Thyroid Test and prescribes Aspirin.
The Thyroid Test is covered by the Insurance, but the Annual Checkup is not. A 55% discount can be availed on Annual Checkup. When the Bill is created, Clinicea will calculate the Patient Co-Pay and Insurance Due and show this calculation for easy understanding. Let us create this step by step.
1. Go to Financials | New Bill | Search and Select Patient.
2. A New Bill window will open.
Now Add Bill Items Ex: Annual Checkup, Thyroid test and inventory item Aspirin.
Now Click on the blue link label (Ex: $1011) next to Ins Owes. On the right a fly-out will come up which will show the rules that have been applied. It will give a detailed breakup of how we arrive the total of what the Patient Owes and what the Insurance Owes.
Now, enter the amount being paid by the PATIENT | select Payment Mode | Save.
3. Once Saved, you will automatically be diverted to Search Bill. The Bill that needs to be paid by the Insurance Company will appear here along with the due amount.
4. If a Patient does not subscribe to an Insurance Policy but while billing if we change Billed to from Patient to Corporate and select an Insurance Company called YourHealth than in this case we can manually enter the Patient Owes and it will automatically allocate the rest amount to the Insurance company.
a. Go to Financials | New Bill | Search and Select Patient in a New Bill | Change Billed To from Patient to Corporate by clicking on the Search icon | Add Bill Items Ex: Annual Check up, Thyroid Test and inventory item Aspirin | Manually fill in the amount that Patient Owes and it will automatically allocate the rest amount to the Insurance company.
b. Now Click on the blue link label (Ex: $298) next to Ins Owes. On the right a flyout will come up which will show the Payment Details. It will give a detailed breakup of how we arrive the total of what the Patient Owes and what the Insurance Owes.
Enter the amount being paid by the PATIENT | select Payment Mode | Save.
Please have a look at How to process Payments from Insurance