Claim Forms: Client Insurance - Box 4, 6, 7, 9, 11
In order to submit a claim properly to insurance, the client's insurance information details must be properly rendered on the claim form. To select an insurance payer while completing the CMS 1500, the insurance details must already be populated in the client's profile.
You can learn more about manually adding client insurance information to their profile, as well as automatically capturing it during onboarding in the resources below:
Select an Insurance Policy on a Claim Form
Once an insurance policy (or multiple policies) has been added to a Client Profile, you can select an insurance payer when completing the claim.
The insurance details for a claim can be directly edited in the claim form after the policy is selected. However, it is important to distinguish between linking a policy and editing policy fields:
- Linking a policy to a claim is claim-local and only affects the specific claim.
- Editing policy fields from within the claim form propagates globally. These edits will update the corresponding details in the Client's Profile and affect all unsubmitted claims linked to this policy.
- Submitted claims are preserved via a static snapshot of the policy data, meaning they will not be retroactively updated by any new policy changes.
Claim Form Details for Insurance (Box 4, 6, 7, 11, 11a, 11c)
The insurance details included in the Healthie claim form automatically render on the CMS claim.
- Patient Relationship to Insured > Box 6
- Insured's Name > Box 4 (this will match the client's Legal Name if self-insured)
- Insured's Address > Box 7
- Insured's Policy Group or Feca Number > Box 11
- Insured's Date of Birth and Gender > Box 11a (These are required fields)
- Insurance Plan Name or Program Name > Box 11c
Secondary Claim Information (Box 9, 9a, 9d and 11d)
You can create a claim that bills to the secondary insurance, or lists an insurance as the secondary when creating your claim.
After adding the Primary insurance to the claim, click Add Policy
Select the secondary insurance from the drop down (the secondary insurance policy must be added to the Client's Profile already in order for the policy to display)
- Make sure the policy type is properly documented as Secondary
By default when a secondary claim is added to the Healthie claim, box 11d "Is there another benefit plan" is marked as YES. The secondary claim details are populated in Box 9.
