Insurance Eligibility Tracker

Healthie's Insurance Eligibility Tracker is an (optional) setting that enables you to keep track of critical insurance information related to a particular client's insurance coverage. This can be useful in understanding how many visits are approved for reimbursement, and how many have been utilized during a specific time period, to help manage and predict likelihood of insurance coverage for a particular client. Additionally you can keep track of a required referral, and indicate that a referral has been obtained for a client. 

For additional automation of workflow, the Insurance Eligibility Tracker is connected to Healthie's Calendar, and the number of visits used and number of visits remaining will automatically update based on a client's scheduled and occurred appointments. 

Enable the Insurance Eligibility Tracker

If you would like to use the Insurance Eligibility Tracker in your business, navigate to Gear Icon (top-right of account) > Settings > Insurance 

A side panel drawer will appear containing a list of insurance-related settings that you can enable/disable for your account. 

Enable "Track Client Insurance Eligibility" 

This setting will display on each client's profile and includes fields for an authorization number, number of visits, start and stop date, visits used, and visits left. For providers, this will allow you to diligently keep track of your client's insurance benefits. 

Add information for a particular client

If you would like to add information that you have received from an insurance company to your Client's Profile, navigate to  Client Profile > Overview > Insurance Authorization > Edit > Add information

You can also manually add an insurance policy (including a secondary or inactive policy) to your client's account within their profile. 

Learn how to onboard & electronically collect insurance details from clients here

Insurance Eligibility

Once your client's insurance information has been added into Healthie, you can then update their Insurance Eligibility details. Return to the overview page of their client profile > Insurance Eligibility > Edit Eligibility.

Select the box "Insurance Authorization Required"

You will be then prompted to enter information including a Client's authorization number, # of authorized visits approved for a client, # of authorized visits used, and effective start / end date. 

Benefits Information

Within the eligibility section of your client's profile, you can add details around your client's benefits. You can add multiple sets of information, for Preventive and/or Medical benefits. 

• Indicate if your client has telehealth coverage 
• Copay amount ($) 
• Coinsurance amount (%) 
• Deductible for the calendar year ($) 
• Deductible used year-to-date ($) 

Coverage 

Add detailed related to conditions and services that are covered under your client's insurance plan.

• Covered CPT codes 
• Covered ICD-10 codes

Referral Details

Additionally, you can indicate if a referral is required/not required for this client. You can return to this section to update whether a required referral has been obtained (or not). 

When you press "Save" you are then able to view this information within the Client's profile. If you have a session occur with the client, this insurance eligibility tracker will automatically update to reflect the reduction in remaining sessions available. You are always able to override this by editing the section directly.

Call Reference Details 

Here you can add the specific reference number, the date & time, and any relevant notes. At this time, you can only add ONE call reference for each client plan. A forthcoming update will allow you to document unlimited call reference numbers. 

Keeping track of available visits

Once a client is booked for a session, an eligible session will be deducted from the "Visits Left" tracker (and added to the "Visits Used" tally) 

However, if any appointments are marked on the calendar as Cancelled, No-Show, or Rescheduled, the visit will automatically be returned to the "Visits Left" tally. 

The eligibility tracker will NOT deduct any past sessions from the moment it has been activated. If your client has already used authorized visits, prior to the tracker being enabled, we suggest that you manually adjust the number of visits accordingly. 

Note: In the event that all the visits are used and the provider or patient goes to schedule an additional session, there will not be any type of alert that prevents a future session to be scheduled.

Automations with regards to expired sessions

If sessions have expired, Healthie's Insurance Eligibility Tracker will alert you that there were unused sessions. 

Integrations with third-party Insurance Eligibility Check Providers

Healthie integrates with third-party insurance eligibility check providers through our Harbor. These include options like Claim MD and others and we encourage you reviewing these options to find the best solution for your business.