Provide Billing Information

1 In the Billing Information section, if the Bill Type list does not display the correct party responsible for paying for the test, click the appropriate one (Client, Patient, or Insurance).

The available options vary, depending on the client that appears in the Client box in the Order Information section. If the Client box is blank or does not display the appropriate client, choose the correct one (as described in Provide Order Information.)

Tip: You can set your default client via your user profile.

Note: For hospital staff members, if the client that appears in the Client box supports the client bill type, Bill Type is automatically set to Client, no matter what bill type might have previously been used for the patient. (Any insurance or guarantor information associated with the patient is retained in the patient record; the bill type is changed only for this order.) If the client does not support the client bill type, you must choose an appropriate option in the list.

If you change Bill Type to Insurance, any existing insurance information associated with the patient does not appear automatically; you must specify it manually later.

Caution! If you are not a hospital staff member and you retrieved an existing patient, the bill type reflects the patient’s current record for the specified client. If you change the bill type to one that requires less data (for example, if you change Insurance or Patient to Client), a prompt appears, asking whether or not you want to change the information in the system.

Click This order only to apply your changes to this order only, or click This patient’s current order and all future orders to update the patient’s record in the system, and then click OK.

If you click This order only, that phrase appears in parentheses next to the Bill Type list. If you click This patient’s current order and all future orders, data associated with the previous bill type (such as the insurance carrier name and insurance ID) might be lost.

2 If Bill Type is set to Patient or Insurance, go to the next step.

If Bill Type is set to Client, go to Specify a Diagnosis.

Note: If the Diagnoses section does not appear, go to Specify a Test. If the Diagnoses section is collapsed and you do not want to provide a diagnosis, go to Specify Standing Order Details (if you are creating a standing order) or Specify a Test.

If you are a physician and the Diagnoses section is expanded, a diagnosis might or might not be required, depending on the client. If you are a hospital staff member and the Diagnoses section is expanded, a diagnosis is required.

3 If no information appears in the Guarantor Information area, or if the displayed information is incorrect, do one of the following:

• To use the patient information as the guarantor information, click Use Patient Info.

If Relationship is set to Spouse or Dependent, only the patient’s address is used for the guarantor. If Relationship is set to Self, then the patient’s name as well as the address are used.

You can change the guarantor information as needed. However, if Relationship is set to Self, and an SSN was specified for the patient, you cannot change the SSN that appears in the Guarantor Information area.

• Provide the appropriate information about the guarantor.

Notes:  

• The number of address lines vary, depending on the lab.

• You can type the zip code in either the City or Zip box and then press Tab to automatically complete the City, State, and Zip fields.

• The Relationship field indicates the relationship of the patient to the guarantor (Self, Spouse, or Dependent).

4 If Bill Type is set to Patient and you want to specify a diagnosis, go to Specify a Diagnosis. Otherwise, go to Specify Standing Order Details (if you are creating a standing order) or Specify a Test. (Hospital staff members cannot create standing orders.)

If Bill Type is set to Insurance, go to the next step.

5 If no information appears in the Insurance Information area, or if the displayed information is incorrect, do one or more of the following:

Notes:  

• The carrier you choose might be changed automatically, based on the location of the client. If this occurs, a message advises you of this.

• If the patient’s current carrier has a contractual agreement regarding lab work, a message indicates where the order should be routed. If the message lists a single lab and you need to change the carrier, you are presented with only carriers associated with that lab. To specify a carrier associated with your current lab, click Override in the message before choosing the carrier.

If the message lists multiple labs and you need to change the carrier, you are presented with the carriers associated with your current lab.

• Select a favorite carrier:

a Click the Primary or Secondary option button, depending on whether you want to specify the primary or secondary insurance carrier.

Note: These option buttons appear only if the lab and client support secondary insurance. If both option buttons appear, a primary carrier is required.

b In the select from list, click the appropriate group of favorites.

Notes:  

• If you have not defined any favorite carriers, and the lab has no custom carriers, this list is blank. For information about adding carriers to your list of favorites, see Manage Favorites via Streamlined Order Entry.

If the lab has any custom carriers, they appear in the Custom Carriers group.

• For some labs, if the client is allowed to use only specific carriers, all of the standard carriers assigned to the client appear in the Available Carriers group, and all of the custom carriers associated with the lab appear in the Custom Carriers group, no matter how you might have set up your favorite carriers via the Setup menu or the legacy Order Entry page.

The favorites in the selected group appear on the page.

Tips: 

• If the carrier information is too long to display in its entirety, an ellipsis (...) appears. You can position the pointer over the displayed information to see the complete information in a pop-up window.

• To sort the listed carriers, click the appropriate column heading. You can click the column heading again to reverse the sort order.

c In the displayed list of favorites, click the appropriate item.

The specified carrier appears in the Carrier box.

• Specify the carrier. Click the Primary or Secondary option button, depending on whether you want to specify the primary or secondary insurance carrier. In the box in the upper-left corner of the section, type the first few characters of the carrier’s name, mnemonic, or other key word. (For example, for the Federal Blue Cross Blue Shield program, you might be able to type the name Blue, the mnemonic FEP, or the key word BCBS.) A list of the first ten matching carriers appears. As you continue typing, this list displays more similar matches. When you see the appropriate carrier in the list, click that item. The specified carrier appears in the Carrier box.

Notes:  

• The Primary and Secondary option buttons appear only if the lab and client support secondary insurance.

• For some labs, if the client is allowed to use only specific carriers, you cannot type in this box. All of the standard carriers assigned to the client appear in the Available Carriers group in the select from list, and all of the custom carriers associated with the lab appear in the Custom Carriers group.

Alternatively, to search for a carrier, follow these steps:

a In the box, type at least two characters of the carrier’s name, mnemonic, or other key word.

For example, for the Federal Blue Cross Blue Shield program, you might type the name Blue, the mnemonic FEP, or the key word BCBS.

b Click Search.

c In the search results, click the appropriate item.

Note: Custom carriers are never included in the search results. To see a list of all custom carriers for the lab, click Custom Carriers in the select from list.

• Swap the primary and secondary carriers. If at least 1 of the insurance carriers is specified, click the Swap Primary/Secondary button to immediately swap the primary and secondary carriers, if needed.

Note: The Swap Primary/Secondary button does not appear if the primary carrier is a generic carrier, or if the selected performing site only allows a primary carrier.

• Remove the carrier. Click next to either Primary or Secondary.

Tip: To change a carrier, you can simply choose a different one as described previously.

• Specify the insurance ID. In the Insurance ID box, type the patient’s insurance ID exactly as it appears on the patient’s insurance card.

• Specify the group number or date of injury (for workers' compensation claims). If appropriate, in the Group Number box, type the patient’s group number exactly as it appears on the patient’s insurance card. For a workers' compensation claim, in the Date of Injury box, type the date of the patient's injury (in MMDDYY format).

Notes:  

• If the carrier has provided insurance eligibility information, and an administrator set up your user account to perform eligibility verification, appears for each appropriate carrier (primary, secondary, or both). However, eligibility verification will occur for the secondary carrier only if the primary carrier did not provide eligibility information. For more information, see Eligibility Verification.

• If the specified insurance carrier, insurance ID, or group number affects which labs can perform the tests, a message advises you of this. You can click Override to have the tests performed at your current lab. However, this might affect patient billing.

6 Respond to any additional prompts that appear.

The information that you are prompted for varies, depending on the carrier. You must provide any required information.

7 If the patient has secondary insurance, click the Secondary option button and then repeat steps 5–6 for the secondary insurance carrier.

Note: If the lab or client does not support secondary insurance, the Primary and Secondary option buttons do not appear.

8 Specify a diagnosis (as described in Specify a Diagnosis).

Note: If the Diagnoses section is collapsed and you do not want to provide a diagnosis, go to Specify Standing Order Details (if you are creating a standing order) or Specify a Test. (Hospital staff members cannot create standing orders.)

If you are a physician and the Diagnoses section is expanded, a diagnosis might or might not be required, depending on the client and carrier. (If you are a hospital staff member and the Diagnoses section is expanded, a diagnosis is required.)