In this article we will show you (step by step) how to save policy limits from Apollo for their application in patient charges.
Configuration
Create or Select Policy
To create or edit a policy, go to Insurance Policy Manager window, select an existing company. To be more specific now choose a Minor Company inside this company (for particular coverage). There you will be able to create or edit a policy and add or edit the coverage values and diseases.
Here you can set the Maximum limit (maximum amount of coverage) and the Approval threshold (values that must be complied in order for their approval), which are values set by the insurance companies:
Create Patient
Now go to Patient Registration window.
If your patient account already exists, click Insurance Information and go to the next step.
If not, click Create button and fill all of the missing information. Save and click Insurance Information.
Assign Policy
In Insurance Information you can assign the policy by entering the insurance information, check NPHIES coverage and enter who will be granted this coverage (which is your patient's name).
After filling all of these fields, click Save.
Application
Create Encounter
Go to Current Encounters window and create a new one by filling all of the missing information. In our example we are creating an encounter for an Outpatient.
Create Charges
For Physicians:
Go to Physician Dashboard, select the Encounter then add Medications and Services to be performed:
Sending Charges
1. Send charges for their approval
Go to Pending Order Authorization window to send these charges for their NPHIES approval. Select an Encounter to see the charges you would like to add:
In Claim Type you will have to choose a claim for the medications or services that you're applying, each one corresponds to medications, dental services, other services and consultation charges.
Select your charges and send them:
Here you can also download the UCAF 2.0 printable document:
Application of Services and Medications
Application of Services
To apply your approved services, go to Service Orders, select the Service and click on Process button:
2. Delivery of Medications
Go to Outpatient Pharmacy Dashboard or to Pharmacy Dashboard (for Inpatients), select your medications , now enter the amount to be delivered and Save.
3. Billing
Go to Multibilling window to apply the charges to the insurance company. In our example all of the charges were covered by the policy:
To perform this action select your charges, add them to an extension and process.
We hope this improves your Cirrus experience. Remember to share this information and ask for help if you need it.
Date: February 28, 2022