Where these updates come from

When a patient pays a bill online, they can also send you updated insurance details. Each submission waits for a biller to review it. Until you do, the app pauses new statements for that patient, so a claim you expect to bill can quietly sit still. Reviewing these promptly keeps statements moving.

Before you start: pick an agency in the agency selector at the top of the page. The Patients list only shows patients for the selected agency.

Finding submissions that need review

You can spot a waiting submission in three places:

  • The Patients item in the menu shows an amber count badge with the number of insurance updates awaiting review.
  • On the Patients list, the Insurance column shows an amber Review badge on each affected patient.
  • On the patient's detail page, an amber box on the Insurance card lists each submission: the insurance company the patient entered, plus Member, Group, Priority, Subscriber, and the date it was submitted.

Reviewing a submission

  1. Click Patients in the menu and open a patient with a Review badge by clicking View on their row.
  2. In the amber box on the Insurance card, check the details the patient sent, then click Review & link.
  3. The Review patient insurance window opens with the patient's details filled in. A note at the top shows the insurance company name the patient typed. Use the Insurance company search to pick the matching company from your payer list; the Payer ID fills in from the company you pick.
  4. Set the Priority (Primary, Secondary, or Tertiary) and check the Member ID and group number.
  5. On the Subscriber tab, fill in who holds the policy. If the patient is their own subscriber, click Copy from patient.
  6. Click Apply insurance. The submission becomes a regular policy on the patient's Insurance card.

If the submission is junk, a duplicate of a policy you already have, or clearly wrong, click Dismiss instead and confirm. Dismissing discards the submission without changing the patient's policies.

Either way, once no submissions are waiting, the patient's claims are eligible for statements again the next time you run Generate Statements (see Patient statements).

Example

The Patients menu badge shows 1. You open the list, find Mary Ellis with a Review badge, and click View. The amber box shows she entered "BCBS" with a new Member ID; she retired last month and switched plans. You click Review & link, search the Insurance company field for her Blue Cross Blue Shield plan, set Priority to Primary, click Copy from patient on the Subscriber tab, and click Apply insurance. Her old plan is still listed, so you click Mark inactive on it. Her next claim can now bill the right payer.

Tips

  • The patient types the insurance company name freehand, so expect abbreviations and misspellings. The search step is where you turn "BCBS" into the exact payer you bill.
  • If a Generate Statements run creates fewer statements than expected, check the Patients menu badge. Waiting submissions are a common reason claims get skipped.
  • After applying a new primary policy, review the patient's other policies and use Mark inactive on any that ended (see The patient detail page).