Patient Insurance Benefits

Let's explore the patient's insurance benefits in CareStack. To do this, you need to navigate to the insurance module.

Check out this resourceful video for a thorough walkthrough of patient insurance benefits:

Let's get started!

• Select the patient using the Global Search bar .
• Click on the Insurance quick link.

• Click on any insurance of your choice.

• Here you can see two tabs namely Patient Eligibility and Fee Schedule Assignment.

• Under Patient Eligibility > Plan Details, you can view Insurance Plan Details including carrier and plan details. 

• The second section provides Patient and Subscriber Insurance Details, including information on account members that share this assignment, Benefits Assignment Settings, and General Coverage.

• To update Insurance Plan Details, click Edit on the right.

• Make the required changes.
• Click Save.

To make in-depth changes to the Plan:

• Click Edit Detailed Plan.
• This will open the Edit Plan slide-out.

• In the View Plan Details slide-out, click Edit.

• Make the required changes as needed.
• Click Save once changes are made.

Edit Patient Benefits & Plan Benefits

To update Patient Benefits:

• Locate the Patient and Subscriber Insurance Details section.
• Click Edit Patient Benefits.

• Make the required changes to patient benefits.
• Click Save.

To update plan benefits:

• Click Edit Patient Benefits.

• Click Edit Plan Benefits.

• Scroll down to locate the General Coverage and Ortho Coverage sections.
  • Make the required changes to patient benefits.
• Click Save to update the changes.
• To update the eligibility along with the changes, click Save and Update Eligibility.

Edit Patient Benefits on Exclusions and Limitations

To edit Patient Benefits on Exclusions and Limitations,

• Click Exclusions and Limitations. 
• Click Edit Patient Benefits.

• Select the required benefits to be enabled.
• Click Save.

To update exclusions and limitations:

• Click Edit Exclusion & Limitation Form.

• Make the required changes on the left.
• Click Save.

Missing Tooth Clause

• To access Missing Tooth Clause, use the Missing Tooth Clause shortcut.

• This will open up the View Plan Details slide out, with the Missing Tooth Clause section selected.

Alternative Benefits

• To access Alternative Benefits, use the quick link.

• You can view the codes in the slide out.
• Click Edit to add any Benefits or Pre-Authorization codes if needed.

• To add a new code, click +Add AMB Code.

• Select the alternative Treatment Code you want to apply against the first treatment code.

• Select Alternate Benefits.
  • Choose a preset from the Select Teeth Preset.
  • Select the Teeth from the tooth selector.
  • Click Apply

• Click +Add Rule to apply a certain treatment code for a particular tooth or teeth.
• Click Save. 

Pre-Authorization

• To access Pre-Authorization, use the quick link.

• This will open up the View Plan Details slide out, with the Pre-Authorization section selected.
• To update, click Edit. 

• Make the required changes.
• Click Save. 

Fee Schedule Assignment

After you add a patient's insurance to their profile, use this workflow to assign a fee schedule to their plan.

• Click Fee Schedule Assignment.
• Click Edit.

• Select Custom Assignment > Click Add.

• Select the intended Fee Schedule and other details such as Location, Location Group, Provider, and Specialty. When a location, provider, and specialty are chosen, this will need to match the fee schedule to apply.
  • Click on the Delete button to delete the insurance from the Fee Schedule.
• Click Save.

Note: When you are providing the Specialty for Fee Schedule Assignment:

• The specialty should match the specialty of the Treatment provider.
• If the specialty is unmatched it will pull the fee from UCR for the plan.

Practices can use this simple guide to learn about patient insurance benefits in CareStack!