Axium: Entering Insurance To enter insurance in Axium follow the directions below: Is the Patient the Policy Holder? If so, we need to indicate this! (Front Desk Primary Responsibility) 1. Select the Patient. 2. Go to the Patient Info by clicking the Modify button. 3. Click the Guarantor tab. 4. Check the Policy Holder check box. 10/7/2015 1
Is the Patient the Policy Holder? If not, we need to add the Policy Holder first! (Front Desk Primary Responsibility) 1. Select the Patient. 2. Go to the Patient Info by clicking the Modify button. 3. Click the Guarantor tab. 4. Click the Lightbulb. 5. In the relationship field, click on the dropdown field and select the relationship to the patient. 6. Complete the Guarantor information fields. 7. Check the Policy Holder check box. 8. Click the Add/+ button. a. If there are additional Guarantors/Policy Holders, follow steps 4 to 8. 9. Click the Save button. 10. Click the Close button. 10/7/2015 2
Adding an Employer (Front Desk Primary Responsibility) 1. Select the Patient. 2. Go to the Patient Info by clicking the Modify button. 3. If the patient has an employer, click the Employer tab. 4. Ensure the person you are entering the employer for is selected. Note: if the Guarantor is the Policy Holder click the Dropdown to select the Guarantor name. 5. Click the box in the employer field. 6. Enter the employer name in the Criteria field and then click on the tab header, Name. 7. Highlight the Employer line item and double click to select. Adding Insurance for a Plan that Already Exists (Front Desk Primary Responsibility) 1. Select the Patient. 2. Go to the Patient Info by clicking the Modify button. 3. Click the Insurance tab. 4. Click the Link to Insurance Benefit Plan button. 5. Enter the Group Number in the Criteria field and then click on the tab header, Group. 6. Highlight the benefit plan line item and double click to select. a. NOTE if there are no results OR the results are incorrect, contact the Insurance Specialist. 10/7/2015 3
7. A Policy Warning will now pop open. Click Yes that you are sure you want to add a policy for this Benefit Plan. 8. Enter the Subscriber # in the field. 9. Enter the Start Date and End Date specified on the insurance card. 10. Click the OK button. 11. Review entry on the Insurance tab. 10/7/2015 4
12. To add additional benefit plans, following steps 8 to 15. a. The benefit plan listed first will be billed first. To define billing order, click the Bill Order button. Use the arrows to set the benefit plan that should be billed first to be listed first. Then click Save and Close. b. Axium allows a patient to have up to two dental benefit plans and two medical benefit plans. 13. After confirming all information has been entered correctly, click the Save button. 14. Check the patient s insurance eligibility. http://sodhelp.umaryland.edu/insuranceeligibilityverification.pdf a. For Commercial Insurance: The eligibility should be confirmed for each visit unless the front desk staff knows that the patient was seen that day or the prior day, in which case, they can review the history to confirm eligibility. i. Click the Eligibility button. ii. If it has been determined to move forward with checking the eligibility, click the OK button. If the patient eligibility has already been run, click the History button. 1. To check History, after clicking the History button, you will see the user, date, and time of when the last eligibility was run. 2. Highlight the line and click the Details button. 10/7/2015 5
iii. Review the Payer, Provider, Subscriber, Coverage type, Coverage Dates, Deductibles & Maximums, Plan Provisions, Coverage, Frequency Limitations, and Age Limitations. The primary goal is to ensure the patient is currently covered under the insurance benefit plan. iv. Go back to Axium, click the OK button. v. Click the Close button. b. For Medical Assistance: For Medical Assistance patients, front desk staff should continue to verify eligibility through the DentaQuest website serves as it is the most accurate and timely system of verification. The verification should be done the day before the scheduled care so that the patients without active insurance can be contacted to reschedule or come with an appropriate form of payment for the scheduled care. 15. Click the Close button. 16. Scan insurance card into Axium. a. Click the Attachment module. b. Click the ID/Ins Card/Legal section under..business. c. Click the Dental/Med Ins Card tab. d. Click the Add/+ button. e. Type a Description in the Description field, such as Dental Insurance card, or Medical Insurance Card. f. Click the Select Source button to ensure the correct scanner is selected, Visioneer Strobe. g. The Visioneer Strobe name should be displayed. Click Select. h. Click the Scan Direct button. i. Since the item that is being scanned is two-sided, click the Duplex option to scan both sides. j. Since the item that is being scanned is smaller than a regular piece of paper, click the AutoCrop to original option. k. Ready to scan! Make sure the item is lined up within the scanner. l. Click the Scan button. m. There should be indication that the scanner scanned something in the Attachment field. Click the OK button. n. Now see the line item in the ID/Ins Card/Legal section. 10/7/2015 6
Adding Benefit Plans that are NOT in Axium (Insurance Primary Responsibility) Adding duplicate insurance benefit plans can create many financial and administrative problems. Prior to adding additional benefit plans in Axium, it is essential to ensure that the plan is not already in the system. 1. Search for the benefit plan. a. Select the Patient. b. Go to the Patient Info by clicking the Modify button. c. Click the Insurance tab. d. Click the Link to Insurance Benefit Plan button. e. Enter the Group Number in the Criteria field and then click on the tab header, Group. f. Highlight the benefit plan line item and double click to select. NOTE if there are no results then you will need to enter the benefit plan. NOTE: A database warning window will pop up should a benefit plan be made active for an insurance company that is still inactive. See below. The first few words explain the issue and the Yes button should be clicked to cancel through the changes. Clicking No will terminate Axium. 10/7/2015 7
2. If you do need to enter the benefit plan, go to Maintenance module. 3. Go to Insurance tab. 4. Determine if insurance company exists as it appears on the insurance card. Double click on Benefit Plans icon. 5. Check the check box for Show for Ins. Co. 6. Click the box to search for the insurance company. 7. Enter the Claims Billing Address in the Criteria field. 8. Click the Address tab. 10/7/2015 8
9. If the insurance company already exists in our system, then a new benefit plan, coverage, and group will just need to be added. Follow the steps below. a. Make notation of the insurance company code. b. Click the X to close out of the window. c. Click the Add/+ button in the Benefit Plan List window. d. Enter the Insurance Company Code in the Plan Insurance field. e. Enter information as it appears on the card. The squared information should be entered. f. Click OK button. g. The insurance benefit plan line item will now be displayed in the benefit plan list window. Double click the line item. 10/7/2015 9
h. Click the Coverage... button. i. Click the Copy button. j. Select the applicable template by double clicking the template line item. k. Click the X to close out of the linked coverage template window. l. For medical plans: Uncheck the Limit check box and enter the Yr End Month and Day. m. Click OK. 10. If the insurance company does NOT exist in our system, then using the next available number scheme add the insurance information as it appears on the insurance card, a new benefit plan, coverage, and group will need to be added. Follow the steps below. a. Within the insurance companies list window, click the Add/+ button. b. Using the next available number scheme, enter a Code (1) using the number scheme and Information (2) as it appears on the insurance card. 1. NUMBER SCHEME: First Letter: D if Dental insurance, M if Medical insurance Next 3 letters: acronym for the insurance company, ie. AET for Aetna Last 2 numbers: next sequential numbers, 01. You must first search for all the insurance companies to determine the next sequential number. 10/7/2015 10
c. FOR DENTAL INSURANCE (SOD Primary Responsibility) 1. Enter Payment Process and Adjust Code. 2. Enter Assignment, Claim Form, and Pre-Auth information. 3. Enter EDI Claims and EDI Version information. 4. Enter EDI Code. 5. Click Save button. 10/7/2015 11
d. FOR MEDICAL INSURANCE (UMOMSA Primary Responsibility) 1. Enter Service Type information. 2. Enter Payment Process and Adjust Code. 3. Enter Claim Form, and Pre-Auth information. 4. Enter Type of Cvg information. 5. Enter Diag. code type ICD-10. 6. Enter EDI Claims and EDI Version information. 7. Enter EDI Code. (Every insurance company has its own EDI code with Emdeon, so this changes.) 8. Click Save button. 10/7/2015 12
e. Enter the Default Age Limits to 26 yrs. 1. Click the Coverage button. 2. Enter the Default Age Limits for Child Cvg and Student Cvg to 26. 3. Click OK. f. Click the Dropdown to setup for transactions and click OK. g. For Medical Insurance, click the Advanced button. 10/7/2015 13
h. For Medical Insurance, the following check box must be UNchecked: Signature Required; the following check boxes must be checked here: Print Treating Doctor s If in box 24J/K (HCFA only); Print Billing Group in Claim Grp # (HCFA) / Additional ID (ADA); and ICD Codes are required for Medical claims. Then click OK. i. For Medical Insurance, click the Form Text button. j. For Medical Insurance, type Please pay doctor in the Claim Form Assignment section and Claim Form Non-Assignment section. Then click OK. Please pay doctor. Please pay doctor. k. Click the Save button in the Insurance Company window. (Make sure to make notation of the insurance company code.) l. Click the X to close out of the insurance companies list window. m. Click the Add/+ button to add a new benefit plan. 10/7/2015 14
n. Enter the Insurance Company Code in the Plan Insurance field. o. Enter information as it appears on the card. The squared information should be entered. p. Click OK button. q. The insurance benefit plan line item will now be displayed in the benefit plan list window. Double click the line item. r. Click the Coverage... button. s. Click the Copy button. t. Select the applicable template by double clicking the template line item. u. Click the X to close out of the linked coverage template window. v. For medical plans: Uncheck the Limit check box and enter the Yr End Month and Day. w. Click OK. Now the insurance benefit plan must be added to the patient. See Adding Insurance for a Plan that Already Exists. 10/7/2015 15
Processing Claims (Insurance Primary Responsibility) It is critical to select the proper practice in both the EDI claims queue window and the print queue window (see pics below) when processing claims. All staff that manage these claims queues MUST see their practice name before proceeding. 10/7/2015 16