When booking a new client as a health insurance appointment, you will need to first have a referral from their doctor, naturopath or chiropractor and their insurance ID# and Group#. You will use Availity or One Health Port to verify the insurance is active and confirm the copay or coinsurance. Then create a new profile with the following information: First & Last Name, phone number, email address, street address.  In the general notes, first add the insurance information. (Example: Kaiser ID# 123456 Grp# 123456 $$ copay or %% coinsurance (self insured/thru spouse: name)) In a second general note, add the referral info.

 

(Example: Rx: date on referral, name of doctor, NPI# for doctor Dx: ICD-10 codes, description of code if available, # of visits, expiration date if any)

 

Rx: 01/01/2001 Dr. Doctor McDoctor NPI# 123456789 Dx: M54.2 (neck pain) 12 visits expires 01/31/2001

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Make sure the digital referral is saved to the Scanned Documents and then added to the client customer files. Delete old referrals if any since it is being replaced with a new one. If the referral is a paper copy, use the scanner to save it to the Scanned Documents file. Name both paper and digital files is the same format: Last, First Name, Referral Date (example: Smith, Joe 04.22.21 Ref)

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Next, you will add a reminder popup to "Scan INS & ID" as a reminder to scan the client's insurance card and ID to add to the files in their profile at their first visits. Once you have scanned this into the Medical Cards and added it to the client customer files, you may delete the note. You then will need to email the intake and cancellation forms to the client to fill out online BEFORE the arrive for their appointment and add a card to have on file in case of late cancellations or no-shows. This can be a debit, credit, HSA for FSA card.

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Once all the above information is collected, you may then schedule the client for massage visits.

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For Kaiser Appointments: As a courtesy, we let our Kaiser patients know that they need to complete the last visit on their existing referral BEFORE requesting a new one. Kaiser will not allow visits from the old referral to rollover. Instead, they start over with the new one, which means the client will lose visits if they send the new referral in before the old one is finished.

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For Premera Appointments: Some Premera plans limit clients to 6 initial visits and then require a pre-authorization for any more appointments regardless of what the referral recommends. You will need to check Evicore and verify if a pre-auth is required or not. If not, in the insurance notes add  "No pre-auth required." If one is, add "FOR WASHINGTON MEMBERS: AFTER THE FIRST 6 TREATMENT VISITS IN AN EPISODE OF CARE, SUBMIT ONLINE REVIEW AT WWW.EVICORE.COM"

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1st Example: Premera ID# MSJ60297222301 Grp# 1000010 10% coinsurance (self insured) - No pre-auth required

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2nd Example: Premera ID# VKH60287325301 Grp# 9516487 $15 copay (self insured) - FOR WASHINGTON MEMBERS: AFTER THE FIRST 6 TREATMENT VISITS IN AN EPISODE OF CARE, SUBMIT ONLINE REVIEW AT WWW.EVICORE.COM