Verify insurance benefits

Verification Of Benefits

Verification of Benefits window can be accessed from the Payer Tab in the Case Information window and is designed to document patient insurance benefit details.

To Verify Benefits For A Patient's Insurance:

1. From the Case Information Window click the Payer tab.

2. Highlight a patient's insurance and click the Verify Insurance button.

3. The verification of benefits window will appear:

The above image is an example of Verification of Benefits window.

Complete the following fields:

o Network Status: Choose between In Network, Out of Network, and Unknown (default), to document whether the patient is in a network that the facility participates in.

o Spoke To: Text box to document name of the insurance support personnel.

o Verification Date: Enter the date benefits were verified on.

o Insurance Effective Of: Enter the date the patient's insurance became active.

o Requires Precertification: Enter whether or not patient needs precertification for services.

o Precertification Instructions: Enter any special instructions for precertifying the patient.

o Deductible: Enter the patient deductible information into the appropriate column (in or out of network). Fields are not required, therefore if patient is in network the out of network benefits can remain at zero.

o Current Deductible Paid: Enter the current amount of the patient's deductible that has been paid. NOTE: this value does not update in real time; it is only designed to document deductible paid at time of verification.

o Therapy Cap: Enter amount of maximum coverage for the patient.

o Therapy Paid to Date: Enter amount of therapy benefits paid at the time of verification. NOTE: this value does not update in real time; it is only designed to document therapy benefits paid at time of verification.

o DME Covered: Check this box if patient has durable medical equipment coverage.

o Co-Insurance: Enter the percent ofpatient's portion of the coverage into this field. For example: If thecoinsurance is 80/20 with the patientresponsible for20%and theinsuranceresponsible for 80% of allowed charges, enter 20 into field.

o Time To File Claim: Enter the number of days that are allowed to file an insurance claim.

o Procedures Codes Not Covered: Enter specific codes that are not covered under the insurance policy. This field is only meant to document, to track non payable code see the CPT Checks topic in TheraOffice Accounting for more information setting up rules for checking procedure codes not covered.

o Modality Limit: Enter the number of modalities that are allowed in this field.

o Notes: Place to enter any other text information or notes.

Verification For Multi-Disciplines

If there are multiple disciplines enabled in TheraOfficetheneach discipline can have seperate verification of benefits. Use the Discipline drop down from the top toolbar to switch between disciplines.

Electronic Verification

TheraOffice can electronically verify benefits for the payer by sending an ANSI 270 eligibility file to Waystar. When complete, the ANSI 271 response file can be read by TheraOffice and then can populate the verification of benefits window. For more information, please see the Electronic Verification topic.