This option allows you to select an insurer in Apollo and search, archive or configure their policies.
How to use it?
1. Create a Policy
1.1 Location of search filters and New Policy button.
1.2 Symbology
Note: Only can select that a benefit, diagnosis, or product needs pre-authorization or is excluded, but not both options at the same time.
1.3 When creating a new policy:
Apollo goes to Cirrus for the corresponding minor companies. If he does not show results, it is a configuration or the one he is looking for is not registered.
Apollo goes to the niffler for the price lists.
The standard name is composed of: "Minor name - Sequence number"
When you choose the Personal option in the Type field, the minor company is the parent company itself. That is why the minor companies will not appear as an option.
Commencement field: Date the agreement was made.
When you mark the check you need pre-authorization at the policy level.
Everything contained in the policy will need authorization, it does not matter if the detail of the benefit does not have this check marked.
2. Assign deductibles and Threshold to the Policy
Now you can add the Maximum limit for Coinsurance, Deductible, Copayment, and Medical Coinsurance.
Coinsurance, Deductible, Copayment, and Medical Coinsurance fields can be added in amount or percentage.
2.1 Priority order for Coinsurance and Deductibles information
Priority 1: Register whit Patient Type and Service station
Priority 2: Register only whit Patient Type
Priority 3: Register only whit Service Station
Priority 4: Registry that has neither Service station nor Patient Type
Priority 5: If there are two alike, take the last one created
If the registered patient does not match any rule with patient type or service station and if there is no blank rule, then the information remains at 0
Example:
For all hospitalization patients regardless of their service station, they will have a 10% coinsurance and the rest of the patients will have 20% coinsurance and 20% medical coinsurance.
2.3 Can choose different type of apply in Threshold
Explanation:
For the options chosen in the image: For an outpatient type in the lab station, the insurer will cover $500 per encounter
If the patient option has been chosen in the Limit will to apply field, it would mean that the patient will cover a maximum limit of $500 per encounter.
3. Add Benefits to the policy.
In the following video, you can also see an example of how to add Products and diagnostics to the benefit
Note: If you added a benefit without a diagnosis.
The benefit will be taken as global and will be applied to any diagnosis that the patient brings
3.1 Benefits Explain.
The detail rules are the first to be verified, then the general benefit information is verified, and finally the policy rules.
50% of drug costs are covered. But daily the insurer will only cover a maximum of $ 1000.
Then Apollo verifies the maximum limits of approval of the benefit and finally the limits established in the general policy.
3.2 Example of benefit without products, with products and with excluded products
3.3 Rules when adding diagnosis to a benefit.
We can add diagnoses to be excluded or require approval for treatment. Otherwise, the policy will automatically cover all Diagnoses.
Apollo considers is excluded and requires pre-authorization options to define which diagnosis will be included in the policy.
In the following list, you can see different cases.
If you only have diagnostics with options:
Options Pre-authorization and is Excluded without checking.
Only this diagnosis is included.The option is Excluded is checked
Include all diagnostics except thisThe option is Pre-authorization is checked
Include all diagnostics except thisThe option is Pre-authorization or Excluded is checked
Include all diagnostics except thisThe option is Pre-authorization and Excluded checked, and another with these options unchecked
Include ONLY the diagnostics aggregated with options uncheckedThe option is Excluded checked and another with options unchecked
Include ONLY the diagnostics aggregated with options uncheckedThe option is Pre-authorization checked and another with options unchecked
Include ONLY the diagnostics aggregated with options unchecked.
In the following video, you can see an example of each of the mentioned rules:
Example to diagnosis added and not added.
What you should know?
Configs
1. First create the business partner insurer in Cirrus.
When entering the window you will be able to see a list with the insurers. These insurers coming from Cirrus so to configure a policy in Apollo you need first to create the business partner insurer in Cirrus. Even the insurer must have a price list configured too.
Into Cirrus:
Make sure the partner is a customer, their price list is set up, and the Invoice to Insurance Company checkbox is checked.
Rules
1. Edit or Delete a policy.
You cannot edit or delete a policy if there is a billed patient account, if you try, the following message will appear: "You can not edit or delete this policy. Please try to make a copy of"
2. Insurance Active.
In order to configure a policy in Apollo, it must exist in Apollo and Cirrus.
The Icon color indicates if the insurance exists in Apollo.
Note: You can create/Activate a Policy, just click on the gray Icon.
Additionals functions
1. Archive, See, and Un-Archive policies
2. Import products or diagnostics
Select a csv file and the records will be inserted at the end.
3. Download file empty or current whit diagnosis.
4. Download the file empty, current, or full of products included in the benefit
Upgrades
1. Download all information of the policy in a .XML archive.
The file contains tabs with the following information: Policy Information, Deductibles, Thresholds, Coverages, and Diagnostics.
To Download: Just click on the contextual menu of the policy and choose Download (.xml) option
Warnings!
When using a patient with an insurer in CIRRUS: If you do not add a diagnosis to your patient, Apollo will default that everything is covered by the insurer!