Health Note (HN) Insurance Overview
How does HN work with Insurance:
HN will ask the patient the following about their primary, secondary, and tertiary insurance (if they have them):
Member ID number,
Group number,
Primary carrier and type to determine a package number (required by Athena)
Card images front and back.
HN will ask the patient about insurance every time to check if the patient’s insurance has changed and is up to date with each appointment.
HN always asks the patient if they have another (supplemental) insurance after the patient has added or updated an insurance. The patient will be asked about insurance up to the Tertiary level.
HN does not delete or update existing insurances in Athena (except when only adding card images). By not updating existing insurance entries HN keeps what may have been more accurate information available to compare to the information provided by the patient. Insurance updates reported by the patient on HN will be added as new insurances in Athena.
Note: If the patient has three existing insurances in Athena and updates each with more than just card images, three new insurances will be added to Athena for a total of six.
HN adds a description of all insurance changes to the appointments’ note section in Athena. It is labeled “HN Insurance updates”. An example note can be seen below.
Example Athena Appointment Note for Health Note Insurance Updates:
With HN insurance staff should:
Review the HN appointment note for any insurance changes reported by the patient.
Check that insurance card images added by the patient are legible and do not need to be scanned by staff at the office.
Check all patient entered information against the images of the patient’s corresponding insurance card images.
Reconcile any newly added insurance information with any pre-existing insurance information.
Note: Patients can and do add/pick the wrong information when adding or updating their insurance. The insurance carrier/package names typically can cause issues. This will in some cases lead to a duplicate of the same insurance with the same member number being added with the wrong carrier/package. If a claim is submitted without staff reconciling the duplicate insurance, the claim will be denied as fraudulent.
Request from the patient over the phone or in person any missing insurance information, for example new card images if they are missing/blurry or to confirm the insurance carrier.
Existing Insurance with Card Images on File
A patient with primary & secondary insurances with card images already in Athena
*In this case there will be no changes to insurance in Athena & no HN insurance Athena appointment note.
Adding Card Images to Existing Insurance
A patient adding card images to an existing primary insurance that was missing them
The existing insurance is updated with a new card image. The only way to know from looking at the insurance section that there has been a change is to look at the “Updated” date listed at the bottom.
The HN insurance appointment note reflects that the card image was updated. Staff should double check that insurance card images taken by patients are clear and readable.
Adding Insurance with No Existing Insurance on File
A patient adding primary insurance with no existing insurance on file
If no insurances are already on file in Athena the insurances added via HN will show in the expected order.
The appointment note indicates the insurance the patient added via HN and that images of the insurance card were also added.
Note: When adding a new insurance patients can make mistakes so all insurances added via HN should be checked by and compared to the actual insurance card by staff.
Adding a New Supplemental Insurance
A patient adding another insurance after approving an existing insurance and card image
The new patient reported primary insurance will appear in the next unused insurance position in Athena.
The newly added insurance may not (as shown) be placed in the patient-indicated position if the patient has other insurances on file. Staff will need to check and reorder insurances as necessary.
The appointment note indicates which insurance the patient indicated was no longer valid and which insurance the patient added via HN.
Note: When adding a new insurance patients can make mistakes so all insurances added via HN should be checked by and compared to the actual insurance card by staff.
Updating an Old Insurance with a New Insurance
The new patient reported primary insurance will appear in the next unused insurance position in Athena.
The newly added insurance may not (as shown) be placed in the patient-indicated position if the patient has other insurances on file. Staff will need to check and reorder insurances as necessary.
The appointment note indicates which insurance the patient indicated was no longer valid and which insurance the patient added via HN.
Note: When adding a new insurance patients can make mistakes so all insurances added via HN should be checked by and compared to the actual insurance card by staff.
Updating an Old Insurance with a New Insurance
A patient updating an existing primary insurance
The new patient-reported primary insurance will appear in the next unused insurance position in Athena. It will not replace the original primary insurance. This is so staff can determine if the patient entered insurance is accurate or not before deleting the old primary insurance.
This means that if the patient has three existing insurances in Athena and updates all three with new insurances there will be a total of six insurances for the patient in Athena.
The appointment note indicates which insurance the patient indicated was no longer valid and which insurance the patient added via HN.
Note: When updating insurance patients can make mistakes so all insurances added via HN should be checked by and compared to the actual insurance card by staff.
Updating an Existing Insurance with a New Card
A patient updates the card images on an existing primary insurance that had outdated card images
Due to the difficulty of matching the carrier name with the correct insurance package, at this point the patient may pick a different (wrong) insurance package than what is already on file.
The carrier choice being the same or not will determine how the insurance is updated in Athena.
Example - patient chooses the same insurance carrier/package that was already on file
The existing insurance is updated with a new card image.
The only way to know from looking at the insurance section that there has been a change is to look at the “Updated” date listed at the bottom.
The HN insurance appointment note reflects that the card image was updated.
Staff should double-check that insurance card images taken by patients are clear and readable.
Example - patient chooses a different insurance carrier/package than what was already on file
A new insurance is added to the next available position in Athena’s insurance section.
Staff will then need to check both insurances and reconcile the information.
Because the patient picked a different insurance package, even though they used the same member number, the note will be the same as if the patient said the old insurance was invalid and added a new insurance.
Note: If the insurance for the patient is submitted as shown, without staff reconciling the information and removing the invalid insurance, when the claim is submitted it will be denied and be marked as fraudulent.
Optional: Return appointment type patient only asked to confirm existing insurance
Optional: Return patients with existing insurance & cards are only asked to confirm their insurance is the same, avoiding duplicates in Athena
Patient answers that insurance on file is current.
Patient answers that insurance on file is not current and needs to be updated.
The user is then prompted to contact the office to update the new information.
There is no change in Athena in this case whether the patient says yes or no in the HN questionnaire. It is up to the patient and staff to communicate and record any changes in insurance in Athena.
If the patient reported their insurance is not the same there will be a note saying it is invalid.
Note: There will not be a HN insurance note if the patient said their insurance stayed the same.
Trying to Enter a Duplicate Insurance
A patient tries to add a duplicate of an existing insurance without card images
This question and the following one only appear If the patient enters a Member ID or card number that is already used on an existing insurance in Athena.
Depending on how the patient answers this question one of the following will happen:
The patient realizes they made a mistake and it is the same insurance (shown here)
The patient says they have a new card. (See Updating an Existing Insurance with a New Card case)
The patient says yes they want to update their existing insurance.
Note: In the third case above the patient will be adding a new insurance and since it is the same member number will likely result in a duplicate insurance with a different package number. Staff will have to reconcile the insurances much like the what can happen in the second case mentioned above.
The patient added a card image and it was updated on the existing insurance.
The note lets staff know there is a new card image to review for the patient’s existing insurance.
Unable to Take a Picture of the Insurance Card
A patient that is unable to take a picture of their insurance card
Staff will always need to check Athena and confirm that a card image was added.
If an appointment note does not say an image was added then it will need to be added by staff through Athena.