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Coverages

Coverage is the reimbursement plan that a patient is subscribed to with an insurance company, who will be paying for the services you provide to the patient. Validations on scheduled services will roll back to the coverage – to make sure the patient has active coverage for the dates of service.

Create a Coverage​

Create a new Coverage by clicking 'New Coverage' on the Coverages subgrid (on a Patient Contact Form) or by clicking the 'New' button on the Coverages Main Grid.

Coverage Information

  • Status Reason - Select ‘Active’ when creating a patient’s active coverage record.
  • Coverage Level - Set whether this is the patient’s primary or secondary coverage.
  • Member (Patient) - prepopulated as the patient whose profile you’re on when adding this record.
  • Member ID - Enter the Member ID as it appears on the patient’s insurance card. The member ID is transferred to the claim. It also enables you to run eligibility checks from within the Autism Care app and receive accurate responses.
  • Relationship - Select the option that best describes the relationship of the member/patient to the policy holder.
  • Policy Holder - Select the contact record of the person that is the policy holder. If the relationship is ‘Self’; the ‘Policy Holder’ should be the patient him/herself, otherwise select one of the patient’s related contacts.
  • Start Date - Enter the start date for this coverage.
  • End Date - Enter the end date for this coverage.
  • Plan - Select the plan the patient is covered under. The options here are based on the plans that you have set up in the system.
  • Payer - Upon selecting the Plan field on the Coverage record, the Payer field displays the name of the payer on the selected plan.

Search Coverages​

Select 'Coverages' on the left navigation bar in the Clinical Area to open the Coverages Main Grid. The Coverages Main Grid has 3 different views, all sorted by the Policy End Date with the older dates displaying first.

  • The Active Coverages view displays all the Active Coverage records in the system.
  • The Draft Coverages view displays all the Draft Coverage records in the system.
  • The Expiring Coverages view displays all the Coverage records in the system where the Policy End Date is in the next 30 days.