Change Patient Data

With the Change Patient Data function, you can change the information stored in your patient accounts:


The Change Patient Data for Family Billing Type and the Change Patient Data for Linking Billing Type sections describe the differences in this function if your practice uses the Family or Linking Billing Types as set up in CGM webPRACTICE Integration Options.

Prior to accessing any of these functions to edit data, you should become familiar with the various Data Input Options and Working with Data instructions.

You must first select the patient account you want to change using the Patient Look-up function. After selecting the account, the Patient Summary screen displays providing an overview of the data stored in the patient account.

Patient Summary Screen
The Patient Summary screen consists of six sections. Click on a section to review or edit the data within that section.

The top two sections display the patient and guarantor information along with any saved image. In the Patient section, the patient's age is calculated and shown in parenthesis next to the birth date (BD) field and the account number is shown in parenthesis next to the patient's name. The Guarantor section, in addition to the basic demographic information, also displays the collection status; last patient and insurance payment date and amount; last statement date; last visit date (the date of the last procedure posted for that patient - which is different from the Last Visit field in the demographics section in the schedule, which pulls the date of the last posted E&M code on the entire account); and the patient, insurance and total account balance. It also displays the Collections balance from the Collections database. It updates in real time as charges, payments and adjustments are posted to the account in the Collections database.

The middle sections display billing and case management information. The Case Management section displays up to seven cases and the balance on each case. When you hover over the case description, the insurance carrier and the employer information for each case displays.

The bottom sections display the primary insurance information and the first of any effective subsequent insurance carriers. If the patient has multiple primary or secondary policies, an asterisk (*) appears next to the Primary Insurance or Secondary Insurance carrier name. If a patient has a tertiary policy, a (T) appears next to the Secondary Insurance carrier name. A CGM webVERIFY status icon will also display if your practice has a current CGM webVERIFY subscription. If you point to the icon, a ScreenTip will state the current status.

CGM webVERIFY Eligibility Status icons: (CGM webVERIFY clients only)

Verification Failed - Red

Verification Passed - Green

Verification Outdated - Grey

Verification Partial - Yellow

Never Verified - Clear - denotes a policy that has never been verified. If you point to the icon, a ScreenTip will state either, 'Never Verified' or 'Never Verified. Carrier does not contain a CGM webVERIFY Identifier.' You can click the Status icon to check eligibility for the carrier

The status icon reflects the status of the specific result being viewed, not the current eligibility status for the policy.

 
An image icon appears in the upper-right corner of either section if an insurance card has been scanned and saved for the policy. You can click the icon to open the card image. When you hover over these sections, detailed insurance carrier information displays in a pop-up window. Click Insurance in the Action Column to view every policy entered and select the policy you want to view or edit. If there are no insurance policies entered on the patient's account, these sections are blank. You can add a new insurance carrier using the Insurance function in the Action Column.

You can change additional patient information using the functions available in the Action Column.


After you make any changes and exit from a section, the patient account is immediately updated to reflect your change(s) and the updated Patient Summary screen refreshes.

Patient Name and Address Information
The Patient Name and Address Information section contains general demographic data and information.

Data Field Information
Prompt Response Req Len
Last Name Type the patient's last name. 60
Suffix Enter the patient's Suffix.   10
First Name Type the patient's first name.   35
Middle Name Type the patient's middle name.   25
Address Line One Type the address for the patient.   35
Address Line Two Type any additional address information.   35
Zip Code Type the five digit zip code or the zip+four. If you type the zip+four, the dash is automatically inserted before the last four digits.   10
City The city automatically populates based on the Zip Code entered, or you can type the name of the city.   20
State Code The state automatically populates based on the Zip Code entered, or you can type the state code or select from the drop-down list.

Click Validate Address to convert the address entered into the standard United States Postal Service format. The Address Line One will be converted; the information in Address Line Two (if standard) moves up to the end of Address Line One; the Zip Code is converted to Zip+4 and the City and State are converted based on the Zip Code. If a standard match cannot be found, messages display to explain. If you disagree with the converted address, you can change it back and save it without the validation changes. These changes will prevent claims from being rejected or added to the Exception report due to an invalid address or state code.

  3
County Select the county code from the County list.   5
Country Code Type the country code or select from the Country list.   2
Subdivision If you selected a country other than the US, select a subdivision from the list.   2
Telephone Type the patient's telephone number.   20
Cell Phone Type the patient's cell phone number.   20
Patient Identifier Type an optional practice-defined identification number or alternate name to search for this patient when using Patient Look-up. For example, a patient's official name on his insurance is William, but the patient only goes by 'Bud'. Type 'Bud' in this field so this patient can be located with Patient Look-up.   20
Social Security# Type the patient's nine digit social security number with or without dashes.   11
Birth Date Type the patient's birth date in a MM-DD-CCYY format or click the calendar icon to select a date. The century will automatically be set to '1900' if only two digits are entered for the year and the year is later than the current year. For example, 06-25-58. 10
DOD Type the patient's date of death in a MM-DD-CCYY format or click the calendar icon to select a date.   10
E-Mail Address Type the patient's e-mail address.   50
Race Select the applicable race from the list. This field is currently used for UDS reporting by Community Health Centers.   1
Sex Select the applicable option to indicate the sex of the patient. 1
Race Other Select an additional race for the patient, if applicable.   1
Sex Orientation Select the applicable option to indicate the sex orientation of the patient.   1
Ethnicity Select the applicable ethnicity from the list. This field is currently used for UDS reporting by CHCs.   1
Sex Orientation-Other If you selected 'Something Else - Please Describe' for the Sex Orientation field, enter the description.   1
Language Type the code you want or select from the Language list.

The available selections in the drop-down list are maintained in the Language Code Table.
  3
Gender Identity Select the applicable option to indicate the gender identity of the patient.   1
Patient Status Select the applicable patient status code from the Status list.

If the patient's Status is changed to Deceased, all future appointments and recalls are automatically deleted.
  2
Gender Identity-Other If you selected 'Additional Gender Category or Other - Please Specify' for the Gender Identity field, enter an explanation.   1
Rel to Guarantor Select the code for the patient's relationship to the guarantor from the Relationship list.

If you select '0 - Same' for the relationship, the patient's name, address, social security number, and e-mail address will automatically be stored in the Guarantor's information. If you make changes to any of these fields on the Patient Information screen, the Guarantor Information screen will automatically be updated. If you make changes to any of these fields on the Guarantor Information screen the Patient Information screen will automatically be updated.

If you select a relationship other than 0 Same and you make changes to any of these fields in the Patient Information screen, you will be asked if the Guarantor information should be updated. If you select a relationship other than 0 Same and you make changes to any of these fields in the Guarantor Information screen, you will be asked if the Patient information should be updated.
2
Class Type the code you want or select from the Class list. The selection list includes items from the Patient Class Table.   3
Responsible Doctor Type the code you want or click the magnifying glass to search the table. 4
Primary Care Doctor Type the code you want or click the magnifying glass to search the table.   6
Referral Source Type the code you want or click the magnifying glass to search the table. 6
Referral Type Type the code you want or select from the Referral Type list. The selection list includes the referral source codes that have been marked as a Referral Type in the Referral Source Table.   6
Default Location Type the code you want as the patient's default location or select from the Location list.   6
Default Diagnosis Type the code you want as the patient's primary, chronic diagnosis code or click the magnifying glass to search the table.

If you do not want to store an ongoing primary diagnosis for this patient, type '0' for 'No Diagnosis Recorded'.

The diagnosis code stored in this field is used for reporting purposes and defaults in the 'Diag 1' field in the Procedure Entry Function unless you have the 'Default DX's at Chg Entry' check box selected in CGM webPRACTICE Default Values (System, Database Maintenance Menu). If you have this check box selected, then it overrides this 'Default Diagnosis' field and it places the last posted diagnosis code in the 'Diag 1' field in the Procedure Entry Function.
10
Date of First Visit Type the date you want or click the calendar icon to select a date. This field defaults in the Patient Registration function to the date stored in the Date of First Visit field in CGM webPRACTICE Default Values (System, Database Maintenance Menu). If no date is stored there, then this field defaults in Patient Registration with the current date (the date the patient is pre-registered or registered). In addition, if you schedule any future appointments for the pre-registered patient account (prior to registering the account), the future appointment date overrides any previous default date. 10
Date Acct Last Reviewed Informational only - indicates when you last reviewed the account data with the patient to confirm it is current. The date is automatically updated when you click the Account Reviewed Action Column button.   10
 
If you need to keep track when the data for a patient account has been reviewed and verified with the patient (for UDS reporting or Meaningful Use), click the Account Reviewed Action Column button, which will automatically update the date stored in the Date Acct Last Reviewed field.
 
You can scan and save a driver's license, photograph, or other form of patient identification using the Acquire Image function in the Action Column. For instructions on scanning, see Image Scanning. You can click on any image saved on the account to view it in various sizes. A new Image Viewer window appears containing the image. You can click on any image saved on the account to view it in various sizes. A new Image Viewer window appears containing the image. You can select percentages in the Zoom list to zoom in and out as needed. You can also click Print to print a copy of the image at the currently selected percentage. See the Insurance section below to see a sample of the image window.
 
If your practice has a current CGM webSCAN subscription, click CGM webSCAN in the Action Column to scan the patient's drivers license. For the benefits of using CGM webSCAN and instructions on scanning, see Scanning with CGM webSCAN.

Guarantor Information
The Guarantor section identifies the person responsible for payment and contains the primary and secondary address information.

Data Field Information
Prompt Response Req Len
Last Name Type the guarantor's last name. 60
Suffix Type the Guarantor's suffix. It may be up to 10 characters.   10
First Name Type the guarantor's first name.   35
Middle Name Type the guarantor's middle name.   25
Address Line One This address is used for the mailing address for the patient's statement unless the 'Primary Address' field in the Billing Information screen is cleared.

If you selected '0 - Same' in the 'Rel to Guarantor' field in the Patient Name and Address Information screen, the patient's name, address, social security number, and e-mail address will default in the Guarantor Information fields. You can edit the guarantor's address if it is different from the address displayed.

If you selected '0 - Same' in the 'Rel to Guarantor' field in the Patient Name and Address Information screen and if you make changes to any of these fields on the Patient Information screen, the Guarantor Information screen will automatically be updated. If you make changes to any of these fields on the Guarantor Information screen the Patient Information screen will automatically be updated.

If you select a relationship other than 0 Same and you make changes to any of these fields in the Patient Information screen, CGM webPRACTICE will ask if the Guarantor information should be updated. If you make changes to any of these fields in the Guarantor Information screen, CGM webPRACTICE will ask if the Patient information should be updated.
  35
Address Line Two Type any additional secondary address information.   35
Zip Code Type the five digit zip code or the zip+four. If you type the zip+four, the dash is automatically inserted before the last four digits.   10
City The city automatically populates based on the Zip Code entered, or you can type the name of the city.   15
State Code The state automatically populates based on the Zip Code entered, or you can type the state code or select from the drop-down list.

Click Validate Address to convert the address entered into the standard United States Postal Service format. The Address Line One will be converted; the information in Address Line Two (if standard) moves up to the end of Address Line One; the Zip Code is converted to Zip+4 and the City and State are converted based on the Zip Code. If a standard match cannot be found, messages display to explain. If you disagree with the converted address, you can change it back and save it without the validation changes. These changes will prevent claims from being rejected or added to the Exception report due to an invalid address or state code.

  3
County Select the county code from the County list.   5
Country Code Type the country code or select from the Country list.   2
Subdivision     3
Telephone Number Type the phone number for the guarantor.   20
Social Security # Type the guarantor's nine digit social security number with or without dashes.   11
Birth Date Type the guarantor's birth date in a MM-DD-CCYY format or click the calendar icon to select a date. The century will automatically be set to '1900' if only two digits are entered for the year and the year is later than the current year. For example, 06-25-58.   10
E-Mail Address Type the guarantor's e-mail address.   40
Secondary Address One Type any secondary address information.

For example if the patient spends six months of the year at his primary residence and six months of the year at a vacation residence, you can type the address of the vacation residence. You would then clear the Primary Address check box on the patient's Billing Information screen and the statements would then go to the patient at this vacation residence address.
  35
Two Type any additional address information.   35
Zip Code Type the five digit zip code or the zip+four for the secondary address. If you type the zip+four, the dash is automatically inserted before the last four digits.   10
City The city automatically populates based on the Zip Code entered, or you can type the name of the city for the secondary address.   15
State Code The state automatically populates based on the Zip Code entered, or you can type the state code or select from the drop-down list for the secondary address.

Click Validate Address to convert the address entered into the standard United States Postal Service format. The Address Line One will be converted; the information in Address Line Two (if standard) moves up to the end of Address Line One; the Zip Code is converted to Zip+4 and the City and State are converted based on the Zip Code. If a standard match cannot be found, messages display to explain. You can still choose to override what is converted by Validate Address by typing in any address information you choose.
  3
County Select the county code from the County list.   5
Country Code Type the country code or select from the Country list.   2
Subdivision     10
Telephone Number Type the phone number for the secondary address.   20

You can scan and save a photograph or other form of guarantor identification using the Acquire Image function in the Action Column. For instructions on scanning, see Image Scanning. You can click any image saved on the account to view it in various sizes. A new Image Viewer window appears containing the image. You can select percentages in the Zoom list to zoom in and out as needed. You can also click Print to print a copy of the image at the currently selected percentage. See the Insurance section below to see a sample of the image window.
 
If your practice has a current CGM webSCAN subscription, click CGM webSCAN in the Action Column to scan the guarantor's drivers license. For instructions on scanning, see Scanning with CGM webSCAN.

Billing
The Billing section contains the information necessary to control how the patient is billed.

Data Field Information
Prompt Response Req Len
Billing Group Type the code you want or click the magnifying glass to search the table.

If the Billing Type for your database is set up as 'Family' or 'Linking' and you change the Billing Group for any of the family members, you will be given the option to update the Billing Group on any or all of the other family members.
3
Fee Schedule (Alternate Fee) Type the fee schedule code you want or select from the Fee Schedule list.

This is required if you store any Alternate Fees in this Fee Schedule. The only way the Alternate Fees will default in the Chg Amt field in the Procedure Entry Function is if the Fee Schedule is entered here.
  5
Medicare Patient If this patient has Medicare, select this check box. This field is used to determine the proper 'accept assignment' setting when posting procedures. For more information, see the Accept Assignment Protocol help section under Introduction, System Processes. 1
Benefits Assignment If you have the patient's signature on file, select this radio button. If this radio button is selected, 'Signature on File' prints in Box 12 and 13 of the CMS-1500 form (and its electronic equivalent). 1
Release of Information If you have the patient's signature on file to authorize the release of medical information to other organizations, select this check box.   1
Alert User If you want the Internal Comment to appear every time this patient's account is accessed, select this check box.

If a DMS Alert, HIPAA, or Family Income record containing a Review Date exists on the patient account, the Alert User field will be overridden and the Alerts window will automatically appear each time the patient's account is accessed.
  1
Internal Comment Type any comment text you want to display whenever this patient's account is accessed using Patient Look-up.   45
Report Comment Type any comment text you want to print whenever this patient's account is printed on a report.   45
Account Description Type an additional account description, if applicable.   45
Send Statement If you want this patient to receive a statement, select this check box. 1
Suppress Collections If you want to suppress this patient account from entering the collection process, select this check box. 1
Primary Address If you want to use the guarantor's primary address for all correspondence, select this check box.   1
Print Aging Message If you want to print aging messages on this patient's statement, select this check box. 1
Finance Charges If you want finance charges to generate for this account, select this check box.

If you select this check box, it can still be overridden by selecting the Suppress Finance Charges check box in the Billing Group Code Table for the patient's Billing Group.

The Service Charge Control File (System, Database Maintenance Menu) must also be completed for finance charges to be added to the account.
1
Statement Comment Type any comment text you want to appear on this patient's statement.   45
Erase Statement Comment If you want to erase the statement comment after it has printed, select this check box. 1
Employment Status Select the patient's employment status from the Employment Status List.   1
Guarantor's Employer Type the guarantor's employer.   30
Employer's Address Type the guarantor's employer's address.   30
Employer's Address 2 Type the guarantor's employer's address 2.   30
Zip Code Type the zip for the guarantor's employer's address.   30
City The guarantor's employer's city automatically populates based on the Zip Code entered, or you can type the name of the city.   20
State The guarantor's employer's state automatically populates based on the Zip Code entered, or you can type the state code or select from the drop-down list.

Click Validate Address to convert the address entered into the standard United States Postal Service format. The Address Line One will be converted; the information in Address Line Two (if standard) moves up to the end of Address Line One; the Zip Code is converted to Zip+4 and the City and State are converted based on the Zip Code. If a standard match cannot be found, messages display to explain. You can still choose to override what is converted by Validate Address by typing in any address information you choose.
  3
Telephone Number Type the telephone number of the guarantor's employer.   20

Case Management
The Case Management section contains any information needed when a patient has a situation that requires special billing, for example, auto accidents or Worker's Compensation. If there are any previously stored cases on the patient account, the Case Management summary screen lists them, starting with the most recent. You can edit, print, delete, or review a case in detail, by selecting it. To select a case, click anywhere in the row containing the case information.


To add a new case, click Add a Case in the Action Column.

Data Field Information
Prompt Response Req Len
Case Type Type the code you want or select from the Case Type list. 5
Case Description Type a description of the case. 45
Accident Type Select the applicable Accident Type option or select None if this case is not related to an accident.   1
Accident State If you selected Auto for the Accident Type, select the state where the accident occurred from the Accident State list.   3
Primary Diagnosis Type the code you want or click the magnifying glass to search the table.   10
Date Last Worked Type the date the patient last worked or click the calendar icon to select a date.   10
Date of Ill, Inj, Lmp Type the date of illness, injury, or last menstrual period or click the calendar icon to select a date.   10
Date of First Visit Type the date of the patient's first visit to your practice for this case or click the calendar icon to select a date.   10
Date First PCP Visit Type the date of the patients first Primary Care Physician (PCP) visit for this case or click the calendar icon to select a date.   10
Start Total Disability Type the date the patient started total disability or click the calendar icon to select a date.   10
End Total Disablity Type the date that total disability ended for the patient or click the calendar icon to select a date.   10
Start Partial Disability Type the date the patient started partial disability or click the calendar icon to select a date.   10
End Partial Disability Type the date that partial disability ended for the patient or click the calendar icon to select a date.   10
Start Light Duty Type the date the patient started light duty or click the calendar icon to select a date.   10
End Type the date that light duty ended for the patient or click the calendar icon to select a date.   10
Date Unable to Work Type the date the patient became unable to work or click the calendar icon to select a date.   10
Date Able to Work Type the date the patient became able to work or click the calendar icon to select a date.   10
Discharge Date/MMI Type the discharge date or the date of Maximum Medical Improvement (MMI) or click the calendar icon to select a date.   10
Restrictions Type any applicable restrictions for this case.   40
Permanent Restrictions Type any applicable permanent restrictions for this case.   40
Billing Group Type the code you want or click the magnifying glass to search the table. (When you enter charges in the Procedure Entry Function, the billing group for the selected case will automatically be stored on each of the charges tied to the case.)   8
Fee Schedule The Fee Schedule is used to provide Alternate Fees and Allowable amounts whenever this Case is selected for a patient. Type the code you want or click the magnifying glass to search the table.   5
Insurance Primary Select the primary insurance carrier that applies to this case from the Primary Carrier list. All primary carriers stored on the account will display along with the policy number. If a carrier has been terminated, the termination date displays next to the policy number.

You should select a primary insurance if the charges assigned to this case should be billed to a primary insurance carrier different from the regular primary insurance stored on the patient account and the policy has the Special Billing check box selected in the Insurance Policy Information screen.

You should leave this field blank if the charges assigned to this case should be billed to the regular primary insurance on the account or select No Insurance if the charges should not be billed to a primary insurance carrier at all.
  5
Secondary Select the secondary insurance carrier that applies to this case from the Secondary Carrier list. All secondary carriers stored on the account will display along with the policy number. If a carrier has been terminated, the termination date displays next to the policy number.

You should select a secondary insurance if the charges assigned to this case should be billed to a secondary insurance carrier different from the regular secondary insurance stored on the patient account and the policy has the 'Special Billing' check box selected in the Insurance Policy Information screen.

You should leave this field blank if the charges assigned to this case should be billed to the regular secondary insurance on the account or select No Insurance if the charges should not be billed to a secondary insurance carrier at all.
  5
Tertiary Type the tertiary insurance carrier code that applies to this case or select from the Tertiary list. All tertiary carriers stored on the account will display along with the policy number. If a carrier has been terminated, the termination date displays next to the policy number.

You should select a tertiary insurance if the charges assigned to this case should be billed to a tertiary insurance carrier different from the regular tertiary insurance stored on the patient account and the policy has the 'Special Billing' check box selected in the Insurance Policy Information screen.

You should leave this field blank if the charges assigned to this case should be billed to the regular tertiary insurance on the account or select No Insurance if the charges should not be billed to a tertiary insurance carrier at all.
  5
Statement Billing If you want transactions for this case to be included on the patients statement, select this check box. 1
Comment Type any applicable comment for this case. This field is strictly informational and does not populate into any other function or print anywhere.   50
Doctor Type the code you want or select from the Doctor list.   3
Therapist Type the code you want or select from the Therapist list.   3
Referring Doctor Type the code you want or click the magnifying glass to search the table.   5
Claim Number Type the claim number for this case.

For electronic workers' compensation claims only, this claim number will override the Policy Number stored in the Insurance Policy Information for the applicable insurance policy.
  25
Adjuster Code Type the name for the adjuster.   5
Case Manager Code Type the code for the case manager.   5
Adjuster Name Type the phone number for the adjuster.   130
Case Manager Name Type the name for the case manager.   130
Adjuster Phone Type the fax number for the adjuster.   20
Case Manager Phone Type the phone number for the case manager.   20
Adjuster Fax Type the name for the case manager.   20
Case Manager Fax Type the fax number for Case Manager.   20
Employer Type the termination date of this case or click the calendar icon to select a date.   5
Termination Date Type the code you want or select from the Protocol list. For additional information see the Protocol Table functions under the Tables menu.   10
Protocol Type the code you want or select from the Protocol list.   8

Primary and Secondary Insurance
The Primary or Secondary Insurance sections displays the active primary insurance carrier and the first of any effective subsequent insurance carriers.

You can scan and save insurance cards using the Acquire Front Img and Acquire Back Img functions in the Action Column. You are not required to save a policy prior to scanning and saving images. For instructions on scanning, see Image Scanning.

If your practice has a current CGM webSCAN subscription, click CGM webSCAN in the Action Column to scan the patient's insurance card. For the benefits of using CGM webSCAN and instructions on scanning, see Scanning with CGM webSCAN.
  
You can click on any image saved on the account to view it in various sizes. A new Image Viewer window appears containing the image. You can select percentages in the Zoom list to zoom in and out as needed. You can also click Print to print a copy of the image at the currently selected percentage. See the Insurance section below to see a sample of the image window.


For information about editing the insurance policy data fields, see the Data Field Information in the Insurance section below.
Action Column Functions

Insurance Policy Information
If there are any previously-stored insurance policies on the account, the Insurance Summary screen lists them. You can edit, print, delete, or review a policy in detail, by selecting it. To select a policy, click anywhere in the row containing the policy information. If there are no insurance policies entered you can add a new policy by clicking Add a Policy in the Action Column.

Each existing policy is displayed with the following information:


After selecting a policy, the data currently stored for the insurance carrier displays.

Data Field Information
Prompt Response Req Len
Insurance Carrier Code Type the code you want or click the magnifying glass to search the table.

NOTE: You cannot edit or delete this code if claims have been submitted to this carrier. You have to terminate this carrier instead. You cannot edit or delete this code if this carrier is tied to a case. You must remove the carrier from the case and as long as there are no claims submitted for this carrier, you can edit or delete the code.
5
Policy Holder (L, S, F, M) Type the policy holder's last name, suffix, first name, and middle name..

NOTE: If Same is selected for the Rel to Guarantor field on the Patient Name and Address Information screen, but the policy holder's name differs from the patient name, an alert message displays.
60
Policy Holder Employer Type the employer code you want or select from the Employer list. This list pulls from the employer information stored in the patient's Employers DMS record.   6
Employer's Name If you do not have the Employers information completed on this account, you can still type the name of the employer or any additional employer information.   40
Group Number Type the group number for this policy.   50
Policy Number Type the patient's policy number for this insurance carrier. The patient's social security number defaults in this field unless the guarantor's social security number is different from the patient's, and in that case the guarantor's number defaults.

If the Policy # Format field is completed in the Insurance Carrier table for this carrier, then the policy number entered here must match that format, otherwise an alert message displays. For more information, see Maintain Insurance Carriers.
20
Pat. Rel to Policy Holder Select the patient's relation to the policy holder. 2
Policy Holder Sex Select the option to indicate the policy holder's sex. 1
Policy Holder Birth Date Type the policy holder's birth date in the format of MM-DD-YYYY or click the calendar icon to select a date.   10
Policy Holder is Employer If the policy holder is the patient's employer, select this check box. If you select this check box, the policy holder's employer information will be sent in the electronic insurance claim file instead of the policy holder's name. For example, if the claim is for a worker's compensation case, the employer is actually the policy holder and needs to be reported on the claim.

NOTE: If you select this check box, but Same is selected for the Rel to Guarantor field on the Patient Name and Address Information screen, an alert message displays.
  1
Carrier Type Select the option to indicate the carrier type for this policy.

If you attempt to change the Carrier Type when there are existing claims for that patient and carrier, that have a status of In Process, Locked, Exception or On Hold, you will receive the following message:  Unable to change the carrier type. Claims have already been filed for this carrier. If there are claims that meet these criteria, you will not be allowed to change the carrier type.

 

In addition, if the insurance carrier is tied to a Case, you will not be allowed to change the carrier type.

1
Effective Date Type the effective date of the policy or click the calendar icon to select a date. 10
Termination Date Type the termination date for this policy or click the calendar icon to select a date.

If you enter a termination date for this carrier, the account is checked to see if any charges were filed to this carrier after the termination date. If there were, a Deny dialog displays stating the open charges for the carrier will be denied and require you to select a Practice Denial code and an optional Insurance Denial code, to deny those charges. The charges that were filed to this carrier after the termination date will be denied, the patient's insurance ledger is updated to reflect 'D' for denied and the charges are moved to the patient balance. No secondary claim will be generated.

If this policy is for a secondary insurance carrier and you want the policy information to still print on the insurance claim for the primary insurance carrier, type the same date in the Termination Date field that exists in the Effective Date field. If you do not want the secondary policy information to print on the insurance claim for the primary insurance carrier, you must make the termination date at least one day later than the effective date.
  10
Card Issue Date Type the card issue date for the policy or click the calendar icon to select a date. If you practice has a current subscription to CGM webVERIFY, some payers require this date when processing eligibility requests. If the field is left blank, the Effective Date of the policy will be submitted instead.  

10

Medicare Supplemental Type This field is required only if this policy is for an Electronic Secondary Medicare carrier. Select the type of policy from the Insurance Type Code list. This field is required by Medicare. If you do not select a type from the list, the claim is automatically sent with 12 - Working Aged Beneficiary or Spouse with Plan.   2
Insurance Type This field is required only if the policy is Medicare, Medicaid, or commercial Medicare   2
Special Billing If this policy should only be billed for certain Cases, select this check box.   1
Bill this Carrier Select the billing option you want to use for this policy when creating insurance claims.
Y - Yes, create an insurance claim for all procedures that have accounting dates falling within the effective and termination dates for this policy and store entries for each procedure in the insurance ledger showing all activity.
N - No, do not create an insurance claim for any procedures for this policy.
C - Courtesy, create an insurance claim for all procedures that have accounting dates falling within the effective and termination dates for this policy but do not store any activity in the insurance ledger.
E - Electronic, this option is for Medigap or Crossover secondary insurance carriers, when the primary carrier automatically forwards the insurance claim electronically to the secondary carrier. This option functions the same as selecting Yes, BUT AN ACTUAL INSURANCE CLAIM IS NOT CREATED IN EITHER THE ELECTRONIC OR PAPER CLAIM FILE.

When a Secondary policy is added to a patient account, the Bill this Carrier option is automatically set to E, IF the secondary Insurance Carrier code has a Medigap number entered in the Insurance Carrier Table and ONLY IF the primary carrier on the patient's account is Medicare. Note: The Primary Insurance Default check box must be selected in System, Database Maintenance Menu, CGM webPRACTICE Default Values, otherwise this functionality will not work.
1
Accept Assignment If you want to accept assignment for this carrier for this patient, select this check box. There are other fields within CGM webPRACTICE that can override this accept assignment setting. For additional information see the Accept Assignment Protocol help section under Introduction, System Processes. 2
Ins Liability/Default Pmt %

Type the default insurance liability percentage followed by a forward slash '/' and then the default payment percentage. This field defaults with the value entered for the Liability/Default Pmt % field in the Insurance Carrier Table.

 

This is actually a two-part question.

The first part - Ins Liability determines what portion of a procedure should go in the insurance balance. If the entire balance is to remain in the insurance balance until the insurance pays, then the response should be 100. If you are collecting a portion at the time of service, the entry should be the portion that will remain in insurance balance. For example: if you are collecting 20% up front, the liability should be 80. The second portion - Default Pmt % is what percentage the carrier actually pays. These two responses should be separated by a forward slash '/'. For example, if this carrier was Medicare, and you do not collect any money at the time of visit, your entry should be 100/80. This is the default response for all Medicare patients, thus maintaining consistency and eliminating errors. If you leave this field blank, the system treats it as if '100' was entered, which means the entire balance would remain in the insurance balance until the insurance pays.

  10
Deductible $ Type the deductible amount for this policy.   10
Co-Payment Amount $ Type the patient's co-payment amount for this policy, if applicable. This amount displays in the Copay field in the Insurance sections on the Patient Summary screen with the Specialist Co-pay amount in Co-Payment/Specialist Co-payment format. 20.00/35.00, for example. This amount also defaults in Patient Check In/Out, depending on the doctor the patient is scheduled with. Click Additional Co-Pays in the Action Column to add co-pay information for specific types of service.   10
Spec Co-Pay $ Type the patient's co-payment amount for specialists under this policy, if applicable. This amount displays in the Copay field in the Insurance sections on the Patient Summary screen with the standard Co-pay amount in Co-Payment/ Specialist Co-payment format. 20.00/35.00, for example. This amount also defaults in Patient Check In/Out, depending on the doctor the patient is scheduled with. Click Additional Co-Pays in the Action Column to add co-pay information for specific types of service.   10
Patient Co-Ins Liability % Type the patient co-insurance liability percentage. When the insurance policy is for a Medicare carrier that has the Insurance Form Type set to ‘C’, enter a value from 0 to 100.   10
Cov Last Ver thru CGM webVERIFY If your practice subscribes to CGM webVERIFY, the date this policy's coverage was last verified on will display. If not, type the date you last verified coverage or click the calendar icon to select a date.   10
Coverage Verified thru CGM webVERIFY By This field is informational only and reflects the user code of the person who last verified this policy - if your practice subscribes to CGM webVERIFY.   10
Coverage Last Verified on This field is for practices that do not subscribe to CGM webVERIFY and want to store a date to indicate when coverage was last verified with this carrier for this patient. Type the date or click the calendar icon to select a date.   10
Coverage Last Verified By This field is informational only is for practices that do not subscribe to CGM webVERIFY. It reflects the user code of the person who was logged in the last time a date was added or changed for the Coverage Last Verified on field.   10
Comment Type any applicable comment for this policy. This field is strictly informational and does not populate into any other function or print anywhere.   40

To scan and save insurance cards images, click the Acquire Front Img and Acquire Back Img functions in the Action Column. You are not required to save a policy prior to scanning and saving images. For instructions on scanning, see Image Scanning in the Introduction, System Processes section of Help.
 
If your practice has a current CGM webSCAN subscription, click CGM webSCAN in the Action Column to scan the patient's insurance card. For instructions on scanning, see Scanning with CGM webSCAN.

You can click on any image saved on the account to view it in various sizes. A new Image Viewer window appears containing the image. You can select percentages in the Zoom list to zoom in and out as needed. You can also click Print to print a copy of the image at the currently selected percentage.



If you want to delete this carrier, click Delete. If there are any outstanding claims that have been filed to this carrier, the Delete function does not display. You must first deny any outstanding charges for this carrier before deleting it. Generally, you should not delete an insurance carrier from a patient's account as it is important to have a record of the coverage history for the patient. If at all possible, you should just terminate the policy by entering a date in the Termination Date field, instead of deleting it. If you choose to delete a carrier, an alert message displays asking you to confirm deleting the policy.


If your practice has a current CGM webVERIFY subscription, the Verify Eligibility function is available in the Action Column. With this function you can verify the patient's insurance coverage for the selected insurance policy. NOTE: Before you use this function, the CGM webVERIFY Integration must be set up properly and the CGM webVERIFY Identifier field in the Insurance Carrier Table must contain the correct identifier for each insurance company. Also, note that your practice is charged for each successful individual verification.


If your practice has a current CGM webVERIFY subscription, the Eligibility History function is available in the Action Column. With this function you can view the history of the verify eligibility requests performed for the selected insurance policy.

If you want to store additional co-pay information for this policy click Additional Co-Pays in the Action Column. The available fields are based on what you have set up in the Co-Payment Code Table. These amounts then default in Patient Check In/Out depending on the doctor the patient is scheduled with.

After you have finished editing the policy, the Insurance Policy Information screen refreshes and you can edit another policy if necessary.

Images
With the Images function you can scan, save, replace, delete, or review the various types of images stored on a patient account. For information about scanning and saving images, see Image Scanning or Image Management.

Upon accessing this function, any images saved on the patient account are accessible. You can expand or collapse each image section by clicking the arrow located at the far right of the section header row. You can also click Expand All in the Action Column to open all of the sections at once.
 


After a section is expanded, you can Acquire, Link, Replace, Delete, and Copy images. For information about acquiring and linking images, see Image Scanning or Image Management.

Click Replace under the image you want to replace. The Acquire Image window displays and you can scan or attach a new image which replaces the older image.

Click Delete under the image you want to delete. A message displays to inform you that the image cannot be retrieved after it is deleted and to let you confirm the deletion.



Click Copy under the image you want to copy to another patient account. Select the account you want to copy the image to from the Patient Look-up screen. An Images screen displays showing which image will be copied, from which account and to which account. In the case of copying an insurance card, you can select which policy you would like the image to copy to.



A message displays to inform you whether or not the image was copied successfully.



You can click on any image saved on the account to view it in various sizes. A new Image Viewer window appears containing the image. You can select percentages in the Zoom list to zoom in and out as needed. You can also click Print to print a copy of the image at the currently selected percentage.



The Image Management section contains the practice-defined folders that you may have created in Maintain Image Types. It also contains the following CGM webPRACTICE image type folders:
 
You can select the order to display the image type folders by selecting Sort by Type or Sort by Date. You can review a listing of the images contained in a folder by expanding it. To expand a folder, click the folder description. You can review any image in the list by clicking the image name. When you are done reviewing images, you can collapse the folder list by clicking the folder description. Click Expand All to expand all of the folders at once.


You can scan and save images for any of the existing practice-defined image types by clicking Scan Document. When the Images window displays, click Acquire Image. For detailed instructions on acquiring images, see Image Scanning.


Data Field Information

To delete images in any of the practice-defined image type folders, you must use the View Images function.

History
With the History function, you can review the patient's transaction history without having to exit this function to access Review Patient Information.

You can view the detail of any transaction by selecting it. To select a transaction, click anywhere in the row containing the transaction information. The transaction detail displays in a new window. When you have finished reviewing the detail, click Close and the Transaction History screen re-displays.

  • Date of Service Look-up Function - With this function, you can review specific transactions for a selected date or date range. For example, the account may contain multiple transactions for the month of May, but you want to focus only on the charges posted for May 29th, and any payments or adjustments allocated to those charges. To select a date, type the date of service in the From and Thru fields or click the calendar icon to select a date in the upper-right section of the transaction history window. Click Refresh in the Action Column to display the transactions for the selected date(s). The account totals listed across the bottom of the screen are for the selected date(s) only. Click Print in the Action Column to print the transaction history for the selected date(s).


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    Transaction History Screen Formats - You can view the Transaction History screen in a variety of formats. Select the format you want from the format list box located in the upper-right corner under the case list box.

    Action Column Functions



    Actions
    The 'Act' (Actions) column on the transaction history screen is only available in Change Patient Data. It is not accessible in Review Patient Information. To use this functionality, select the check box(es) next to the transaction(s) you want to change (1), then select an action from the Actions list (2). If you try to access these functions without having the required security level, a warning message displays and you will not be able to continue with the action.