For customers in the United States, Sensei Cloud supports an unlimited number of patient insurance plans. Each patient can have one Primary, one Secondary, and multiple plans designated as Other.
A patient's associated insurance policies are visible from the Patient Snapshot, the Patient Home Page, and the Patient Record.
Note: When submitting claims for a set of charges, it is recommended that you submit to Primary insurance first and await a response, and then submit to Secondary.
Adding a Patient Policy
To enter an insurance policy for a patient:
- From the Patient tab, select Patient Record, and then click Edit Patient Record.
- Under Jump To, click Insurance Information. Any existing policies are listed, along with the Status and Type.
Note: You can also access this section of the Patient Record using the Update Insurance button on the Home page. You can edit or remove plans as needed, and then click Update.
- Select Add Insurance Policy. The Create Insurance Policy window is displayed.
- For Coverage, select Primary, Secondary, or Other.
Note: If you select Primary when adding a second policy, the previous Primary policy becomes Secondary.
- Select the Policyholder and Patient Relationship to Policyholder if the policyholder is not the patient (Self).
- In the Associated Plan field, start typing the name of the plan you want to enter. If the plan is in the system, select it from the list.
Note: If the plan is not in the list, you are prompted to create it. For more information, see Creating a New Insurance Plan.
- Enter the Subscriber / Member ID number and Effective Date of the policy.
Note: Effective Date defaults to the first of the year, but can be edited. This date must fall on or before the service date of the procedures to be billed.
- For Assignment of Benefits, select Assigned if the insurance company reimburses the provider directly, or Not Assigned if reimbursement goes to the patient.
Note: This value is reflected in Box 37 of the ADA Claim form. When Assigned is selected, Box 37 automatically displays Signature on File and the current date when the claim is printed. When Not Assigned is selected, Box 37 is left blank.
- Select the Eligibility / Status: Active, Inactive, or Unverified.
- Enter the Deductible Remaining and Benefits Remaining amounts.
Note: These amounts impact the insurance estimation calculation and must be manually updated to ensure that insurance estimation is accurate. The values default based on the associated plan, but if the plan is set to $0 or if the patient's policy details are modified to $0 (or other small amount), then the estimated insurance coverage will inaccurately display as $0.
- Click Create.
- Click Save Patient.
There are two places to enter a new plan into your system:
- When adding patient insurance, you are prompted to create a plan that is not already in the system. Click Create PlanName.
- From the Administration tab, select Insurance > Plans, and then click Add New Plan.
The Create New Insurance Plan window is displayed.
- Select the Plan Type: Dental or Medical. If Medical, you are prompted to select the Medical Insurance Type.
- Complete the Plan Information section: Contracted, Name, Payer, and Group Number.
- For Contact Information, enter the details if different from the Payer.
- Enter the Fee Coverage Information details for they plan, and then click Create. The plan is added to the list of insurance plans for the practice, and can be managed from the Insurance Plans screen (Administration > Insurance > Plans).
For more information, see How to Set Coverage Details and Benefits by Category on an Insurance Plan.