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Working with Claim Submissions and Online Insurer Portals

We have many Jane users working with online portals to bill insurance companies directly for their client’s visits. This might be Medavie Blue Cross, your provincial Blue Cross, Telus E-Claims (including WSIB), HCAI etc.

This guide will cover the general steps you’ll want to take in Jane in order to properly record these portal submissions. We also have a great video online that walks you through the process: Insurance: Billing a Visit to a 3rd Party

Feel free to scroll right by any steps you’re already familiar with :)

Registering with Insurers

Before you’ll be able to direct bill to different insurance providers, you’ll need to register for direct billing with each insurer. The process will look a little different depending on the insurer, but many of them offer the option to register entirely online.

Registering for RCMP/DVA Provider Services​ ​Here’s where you can find the information for registering for the portal for RCMP

Registering for Pacific Blue Cross (BC) ​And although they’re the same name, the Pacific Blue Cross is a different portal to the Medavie portal.​​ Here’s where you can find the information for registering for the portal for BC Blue Cross

Keep in mind that we are now integrated with Pacific Blue Cross!

Registering for Telus e-Claims This is the portal used by many different National Insurers as well as WSIB in Ontario.

Here’s where you can go to learn more about registering for the Telus Health Portal

Creating the Insurer

The first step is to set up the insurance company you are looking to bill to. You will want to head over to Settings > Insurers and click on New Insurer. For any payers you’re billing to outside of Jane, you’ll use the Regular Insurance/3rd Party Payer/Lawyer:

Feel free to add any contact information as well as a URL portal link that will allow you to launch the portal website directly from the Jane claim area later on.

Here are some of the common portal addresses:

Medavie Blue Cross: https://secure.medavie.bluecross.ca/eai/login

Pacific Blue Cross: https://service.pac.bluecross.ca/ACESWeb/Pages/Authentication/SignIn.aspx?userType=4

Telus E-Claims: https://providereservices.telushealth.com/

HCAI: https://www.hcai.ca/HCAI.Web/Login.aspx

ICBC Health Service Provider Invoice http://partners.icbc.com/health-services/docs/CL392.pdf (while not a portal this will launch the invoice directly from the claim screen for you to fill out and then save to submit via email or fax)

ICBC Chiro Initial/Discharge Report https://onlinebusiness.icbc.com/eforms/dotcom/jsp/CL470.jsp (also not a portal for billing but you can link your ICBC Chiro Flat Fee Program insurance to this form for easy access from the claim screen)

You can review this help document for more details on setting up an insurer

Create a Policy (formerly known as a Claim)

You can now use that insurer to create a new policy for the patient. You can either do this from the Insurance Info section of the appointment pane by choosing Add Policy and choosing the Add New Policy Option…

… or you can create the policy independent of an appointment in the patient’s profile. Just head over to Billing > Insurance Policies and click New Insurance Policy on the right:

There are a bunch of fields you can use in this area, things like how much coverage the policy has, information for an adjuster, and more. The only required field is the Claim Identification Number in the top right, but you can add in any other information you think might be helpful.

For example, you can enter that a policy covers $500 over the course of the year. Then when the policy has reached $500, Jane will alert you that the maximum has been reached.

Another helpful area is the Default Coverage Amounts. Let’s say you have a patient whose Manulife always covers 80% - you can enter it as a default so that it carries over for all appointments under that policy, and you’ll only need to edit it as needed:

Insuring the Appointment

Once you’ve got your policy created, or if you want to create the policy at the time of adding it to the appointment, you can do that over in your Schedule. Just click on the appointment and under that Insurance Info area on the right you’ll find the spot to Add Policy:

Here’s where you can choose to use a policy already created, or you can create your policy right now. Since we went over creating a policy above, let’s use that policy we just made:

With the insurer added to the appointment, you’ll see a couple of changes. First, the appointment will now have a briefcase on it and the name of the insurer to indicate that another payer is involved:

As well, unless your policy has default coverage amounts, Jane will assume that the insurer is paying 100% of the visit. So when we Arrive the appointment, we’ll see that dollar sign badge appear as well since there isn’t any patient payment needed if the insurer is covering 100%:

Working with the Visit

So your appointment is insured, and your patient walks through the door, we can go ahead and Arrive the appointment to indicate that.

You can now head over to your portal to do your submission. If you entered in the portal URL when setting up the insurer, you can jump to the portal right from here:

You’ll do your submission, and once you have your result, you can come back to Jane to enter it. Click on your appointment, and down in the Insurance Info area you can enter this in a couple of different ways.

If you know the percentage being covered, you can enter that in the Percent Coverage area. Or if the portal gave you a number of dollars covered, you can enter that in the Max Amount area.

For either, if you have that Patient Pays Remaining toggle on, Jane will bounce any remaining amount not covered to the patient:

Once you’ve entered in the coverage, you can even mark the appointment as submitted to show that this has been done:

For all appointments covered in-full or in-part by an insurer, you’ll see that the visit splits into two invoices, one for the patient and one for the insurer. Even if the patient isn’t paying anything, it’s totally normal to see a $0 patient invoice :)

Something else to note is that you can enter in the coverage before or after arriving the appointment. Either works!

The last step here is collecting payment from your patient, if they owe a balance. To do that, you can just scroll back up on the right and click Pay, and Jane will show the patient as owing just the amount leftover:

Reconciling Claims

Now that you’ve collected payment from the insurer, we can enter that into Jane so that the insurer’s invoice is no longer unpaid. There are two ways to enter in an insurer payment:

Marking the claim as Pay & Approve:

This will mark just the single-appointment as paid by insurer cheque for today’s date. If you’d like to enter in a payment for another date or payment method, you can edit these payments after entering them, or you can enter your payments using method 2.

Using the Record Payment in Detail Option:

You can use the dropdown from the Insurance Info area and choose this option, or you can simply head into your main Billing tab and into the Insurer Invoices area to create a New Payment:

This area will allow you to enter in the total amount being paid (including if you’re paying off a few invoices with a lump-sum payment), enter in the payment date, and choose your payment method:

Once you’ve entered in those details you can click Next and choose which invoice(s) to Apply that payment to. You’ll be able to search for the patient or invoice, or you can simply view all of the outstanding invoices for the insurer:

Jane will allow you to apply the payment until there is no balance left to apply, then voila! You’re all done :)

Bonus Information!

Claim Submissions

There’s an area under that main Billing tab called Claim Submissions where you can view all of the invoices in each state (Unsubmitted, Submitted, Etc.) as well as that Insurer Invoices area where you can view the purchases and payments for each insurer:

Fillable Forms

We have a super handy feature called Fillable Forms that will help you to pre-fill any of the fields on that form Jane is able to so that you have less to enter in manually. Feel free to check out the linked guide on this!

Further Reading

Claim Submission: Draft vs. Unsubmitted

Setting up Insurers

Grouping Invoices

Paper or Group Invoicing

Receiving Insurer Payment

Setting Up (Pre-)Fillable Insurance PDF Forms