4.2 Primary Insurance

For insured patients, it is important to populate all of the required fields within this section.
Primary Insurance:

1. Select Insurance Company from the drop-down. You may also click the '+' to add Insurance Company if they are not already added to the system.
2. Enter Insurance ID # & Group Number if applicable (It populates Box 11 on HCFA)
3. INSURANCE PLAN: If applicable, can select from plans already added to system, or click '+' & add a plan under the Insurance Company
4. Effective Dates
   1. Add Effective Date & Termination Date (Insurance policies normally renew annually and you can set the termination date to one year out or even longer)

1. Co-Pay | Co-Insurance % | Deductible
   1. Co-Pay is the only active field and system will use this info when generating billing to calculate Patient Responsibility
   2. Co-Insurance % and Deductible are there as a reference.

Financially Responsible Party:

If 'SELF' is chosen it automatically populates fields. If Other Party is chosen, you'll have to fill in required details. The financially responsible party is normally the main beneficiary that the health care plan/policy is named under.

Select 'EMPLOYMENT' to populate box 10a as an 'Employment' accident.  Prior to selecting 'Employment', you will need to enter in the patient's employment information.  Please see Section 6.1.

Patient's Condition Related To:

1. Check 'Accident' if Auto-Related & 'Other Accident' if slip & fall or Workers Comp.
   1. Must Select 'State' from the drop-down menu on the right if related to any type of accident.
2. Other Claim ID Number: For Claim numbers relating to accident etc.… (Box 11b on HCFA)
3. Box 14 - 'Occurrence/Onset Date' W/Qualifier – 431 must be selected
4. Box 15 - Can be used to identify certain treatment dates/types
   1. If this is a MEDICARE patient you must populate the Initial Treatment Date with Qualifier 454 – this is REQUIRED for Medicare.
5. Box 16: If patient is being written off work
6. Box 17 Qualifier: For Referring Provider (if there is one, must add Doctor below in 'Referring Provider ')
7. Box 19: Commonly used to provide additional info to Payer.

Referring Doctor (Required for Box 17 Qualifier):

1. Select Referring Dr. Name from the drop-down menu or click the '+' to add a new Provider into the system