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Patient Insurance

Insurance List
This page lists the patient's contracted health plan(s) with BTMG. It displays when when you click the ELIGIBILITY tab.

Health Plan

The selected patient's contracted health plan(s) with BTMG. This includes both active and terminated contracts.

Click the link to display the Enrollment Detail for the plan.

Member Number
The patient's health plan ID number. This is the same as the contract number. This is a unique number for the patient. The Member Number does not include the subscriber's social security number. However, if the SSN is the member's MRN, the SSN will display in this field.

Rel
The relationship of the patient to the Subscriber.

Subscriber Name
The Subscriber for the selected patient.

Eff Dt
The effective date of the contract. This is a critical field to review in order to determine which contract to select for the specific date of service.

Term Dt
The termination date of the contract.




Enrollment Detail
This page displays information about the individual health plan that was selected from the patient's INSURANCE LIST.

For information about service categories (allergy, prescription drugs, etc.), click the Plan Detail button.

FIELDS:


Contract
The patient's health plan ID number.

Date of Service
Defaults to today. Click the [...] button to display a Calendar and select a different date.

Effective
The patient's effective date with BTMG.

Member No.
The patient's health plan ID number.

Member Type
Indicates if the patient is the subscriber or related to the subscriber. The choices are Subscriber, Spouse, or Dependent.

Member Status
The status of the patient. If it states "SPLIT FAM," then the patient is not active with BTMG for that date of service.

Health Plan
The patient's health plan.

Copay
The patient's co-payment(s) for a general office visit.



PCP:
The patient's primary care provider (PCP) for the date of service entered in the DATE OF SERVICE field.

Med Prac
The name of the PCP's practice.

Member Employer Group Number
The Member Employer Group Number.

PCP HISTORY:
The date range shown here does not reflect the contract-effective date.

Eff Dt
The date that the patient was effective with the PCP.

Term Dt
The date that the patient terminated with the PCP.

PCP
The name of the PCP.



BUTTONS:

Plan Detail
Displays the PLAN DETAIL screen.

Insurance List
Returns you to the patient's INSURANCE LIST.






Plan Detail
This page provides information about benefit coverage, exceptions by service category, and service-specific co-payments.

FIELDS:


Health Plan
The health plan selected in the ENROLLMENT DETAIL screen.

Service Category
The service category selected from the drop-down list.



BENEFIT COVERAGE:
Indicates whether the Service Category as a whole is Covered or Not Covered.



ADJUDICATION DETAIL:
Information related to claims and financial responsibility, such as patient co-payments.

Description
Patient Copay

Multiplier
Number of units.

Amount
Percentage.

Benefit Exceptions
Indicates specific services that are not covered.

Description
Identifies the exception.



BUTTONS:

Enrollment Detail
Returns you to the ENROLLMENT DETAIL screen.

Insurance List
Returns you to the patient?s INSURANCE LIST.