Opening a patient record

Click Patients in the menu, then click View on a row to open that patient's detail page.

The top of the page shows the patient's name, Patient #, date of birth with age, and sex, along with two counts: how many claims the patient has and how many active insurance plans are on file. If this patient was merged into another record, an amber banner at the top links to the surviving patient.

Sections

  • Demographics - name, date of birth, sex, address, city and state, ZIP, phone, and email.
  • Insurance - each policy on file with the payer name, Member ID, Group, priority (Primary, Secondary, or Tertiary), and Effective and Ends dates. Inactive policies are dimmed and tagged Inactive.
  • Merged patients - only shown when this record has absorbed another patient through a merge. Lists each merged-in record with the claims that came across.
  • Claims - the patient's most recent claims with claim number, incident number, payer, status, and call date. Click Open on a row to go to the claim.

Keeping the record up to date

Click Edit on the Demographics card to correct the patient's name, date of birth, sex, address, phone, or email, then click Save changes.

On the Insurance card, click Add insurance to add a policy. Each policy row has an Edit button, a priority dropdown for reordering Primary, Secondary, and Tertiary, and a Mark inactive button that retires a policy without deleting it. If a policy comes back into play later, the same button reads Mark active.

This page is where you fix a bad address or add missing coverage before the next bill goes out, whether you transmit claims through your clearinghouse or print them on paper (see CMS-1500 paper claims).

Reviewing insurance the patient sent

When a patient updates their insurance through the online payment page, it appears in an amber box on the Insurance card marked as needing review. Click Review & link to check the details and save it as a policy, or Dismiss to discard it. While a submission is waiting for review, new statements for that patient are paused, so handle these promptly. See Reviewing insurance updates patients send you for the full walkthrough.

Example

A patient calls to ask why they received a bill. You open their detail page, scan the Claims list, and find a $250 open balance on a recent claim. You click Open on that row to see the full details and explain the charge. While you have them on the phone, they mention they moved last month, so you click Edit on the Demographics card, update the address, and click Save changes.

Tips

  • If a patient has many claims, look at the dates and statuses to quickly find the one they are asking about.
  • If you notice a patient has duplicate records (two entries for the same person), merge them (see merging patients).