Entering Patient Insurance Benefit Information

A patient's insurance policy benefit information (Co-pay, deductible remaining, co-insurance, etc.) can be added into EZDERM via the patient's Insurance Profile. This information can then easily be viewed from the Schedule screen per patient, and it is also a requirement to be able to use the Cost Estimator/Payment Calculator tool.

Go to the patient's chart, click on Insurance Profile, make sure the patient's eligibility check is approved (you can still enter benefit information if the check is not approved if you know the information), and click on the Elg/Benefits button.

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If there was no information documented in this section for the patient (which will always be the case for new patients), then you will need to click on the blue "Add New" text in the top right of the screen. For patients who have already had this information entered, you will be able to see a list of previous benefit information, with the most recent and active entry at the top of the list.

Once you click Add New, you will see the different options for policy benefits that can be entered for the patient, such as Deductible Remaining, Co-Insurance, Co-Pay, and Out of Pocket Remaining.

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If the patient's eligibility check was successfully run, then you will have the option to populate the information in each of those fields from a dropdown menu containing the exact same information in the eligibility report. To do so, click on the small triangle to the left of each field and then select the applicable option. (Things to keep in mind when choosing from the drop-down: Is it a family or individual plan? Is it in-network? Look for Specialist fees).

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Co-Pay Applies to Procedures:

Co-Pay amount is usually applied to the E&M code. But if the encounter does not have E&M code, the patient can be charged for Co-Pay amount if the “Co-Pay applies to CPT” (co-pay may be applied to the CPT code in this case). This cannot be done if Co-Pay does not apply to CPT.

Co-Pay Applies to Out of Pocket (OOP):

If Co-Pay is not included in OOP, the patient will be charged for the full amount of Co-Pay - it does not matter if the OOP is zero or greater than zero.

If Co-Pay is included in OOP, the patient will be charged for Co-Pay only if the OOP greater than zero.

Once this information has been entered and saved, you will see it from the Elg/Benefits page of the patient's chart. You will also be able to see this information directly from the schedule screen by clicking on the patient's appointment once.

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Please note that the patient Benefit information needs to be updated each time that the patient comes into the practice for an appointment. The eligibility report will be updated and show the most up to date numbers if insurance has made payments on prior claims, but that information will still need to be selected from the Elg/Benefits dropdown menu.

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