This is a guide to show you where to enter your client's insurance information into the system. 

We recommend keeping a copy of your client's card on file in your General Documents. Here is more on how to do that: 


Upload General Documents

The Insurer box is where you will choose the client's insurance company from your database of Insurers. 

If you need to add a new insurer to your database, click on "manage insurers" Here is more information on how to do that. 

Setting Up Insurers

Insurer

Insured ID

The Insured ID is where you will enter the client's ID number from their insurance card. This is also commonly called the Policy Number

Plan Name

If the client's policy has a plan name it will be listed on their card. You can enter that information here. It is not required. If a plan name does not appear on their card, it is likely they do not have one

Effective Date

This is the date the client's policy became effective. You can get this information when checking the client's Benefits and Eligibility

Policy or FECA Number

The FECA number is used in cases of Federal Workman's comp claims. Generally this box will be left blank. 

TIP: In certain instances Medicare requires you to enter the word "NONE" into box 11 to show in good faith that you verified the client does not have another policy primary to Medicare. In those cases you can enter "NONE" into this field to satisfy Medicare requirements. 

Group Number 

If the client's policy has a group number it will be listed on their card. You can enter that information here. It is not required. If a group number does not appear on their card, it is likely they do not have one

Plan Subscriber Employer 

This is the name of the Policy Holder's employer. If this is an employee policy the employer should be listed on the client's card. 

Co-Pay Amount

You can enter the client's co-pay information here. This will prompt the client's co-pay to appear on the Agenda, as well as on the invoices. 

Contracted Rate with Insurer 

This is your contracted rate with the insurance company. Note: this box is informational only and will not automatically add a contractual to your invoices. 

Deductible Amount
This is the field where you can enter your client's deductible amount after verifying insurance benefits.

Remaining Deductible Amount
Field does not automatically update but must be manually updated. Will show how much of the deductible is still left to be met. 

Out of Pocket Max
The most your client will have to pay for covered services in a plan year. After they spend this amount on deductibles, copayments, and coinsurance, their health plan pays 100% of the costs of covered benefits.

Deductible End Date
A calendar year deductible, which is what most health plans operate on, begins onJanuary 1st and ends on December 31st. Calendar-year deductibles reset everyJanuary 1st. A plan year deductible resets on the renewal date of your client's plan. 

Co-insurance Amount
 co-insurance is a percentage of the cost for a health service or prescription drug paid by a member after they have reached their deductible. This amount will show on the agenda. 

 

Prior Authorization Number 

If the client's service requires and Authorization you can enter in the authorization number given. 

Plan Subscriber Name 

This is the name of the policy holder. It is informational only and does not transfer into the claim. Please see the Insured ID section below for information on the policy holder.

Set Re-Authorization Reminder 

You can enter in the number of approved units. TheraNest will count down the number of "kept" appointments and notify you when the auth needs to be renewed. Here is more information on that:

Re-Authorization Reminders 

To "Accept Assignment" mean you are accepting the Payers contract rate. If you in network with the insurance you must mark "Yes" 

To "Authorize Payment to Provider" means you want the payment sent directly to you. 

If you are billing Out of Network you can choose how you want to handle these options.

Here is more information on Out of Network Billing

Submitting Out of Network Claims in TheraNest

Accept Assignment and Authorize Payment to Provider

 

Choosing "Yes" means that the client has authorized you to release any medical information necessary to process this claim. This includes diagnosis, procedure, and notes if requested by insurance. 

Note: TheraNest does NOT send your records to insurance. If a payer requests medical records they would need to be printed/dowloaded and faxed or mailed to the payer. 

Release Medical Records and Billing Info to Insurance

If your client's condition is related to an auto accident or workman's comp you can complete this information below

Client Condition Related to an Accident? 

Insurance Information Verified by:
This is a field in which the staff member who verified the insurance benefits can be selected. If this field is marked as "select one" either that option was not chose or the client updated it via the client portal.

Relationship to the Insured

This is the client's relationship to the Insured ~  or policy holder.
   
TIP: If the Client is the Child of policy holder relationship is: Child

TheraNest requires that Policy Holder information is complete before sending claims. 

TIP: Be sure to complete the Policy Holder's gender field. The "Undefined" gender entry often causes rejections. 

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