Add or Edit Insurance Information

1 In the Insurance area, do one of the following:

• If no insurance information appears, click Add Insurance Information.

• If the displayed information is incorrect, click Edit.

• If the lab and client support secondary insurance and 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.

Notes:   • You can use only carriers that the client supports. If you cannot choose a particular carrier, the client does not support that carrier. In addition, the chosen carrier might change automatically, based on the location of the client or facility. If this occurs, a message advises you of this. • If you change the client after specifying the carrier, the carrier might change or be removed automatically, depending on which bill types and carriers the client supports, and where the client is located. • If the patient’s insurance ID or group number triggers the use of a different carrier, a message explaining this appears in the Insurance area after you click OK. • 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.

2 On the Add/Edit Insurance Information dialog box, do one or more of the following:

• Select a favorite carrier. If groups of favorites appear on the left side of the dialog box, click the appropriate group, and then click the insurance carrier.

Notes:   • For generic carriers, the name of the associated generic lab appears in brackets after the carrier’s name. For more information about carriers, see Guarantor and Insurance Information . • For information about managing your favorite carriers from this page, see Manage Favorites via Order Entry.

• Select a carrier from the list. In the carrier list on the right side of the dialog box, click the appropriate one. (You can type a letter in this list to jump to the carriers whose name begins with that letter.)

The name of the carrier is followed by its mnemonic in brackets. In some cases, the city, state, and zip code of the carrier appear to help you choose the appropriate one.

If the carrier does not appear in the expected place in the list, it might be in the system under a slightly different name. (For example, Blue Cross and Blue Shield might be listed as BCBS.)

• Search for a carrier:

a In the Carrier box, type at least two characters of the carrier’s name.

Depending on the configuration of the lab and carrier, you might be able to search for other key words as well, such as the carrier’s mnemonic, address, or other terms.

b Click Search.

All standard carriers that match the specified text appear in the dialog box. (The search results do not include custom or generic carriers.)

If more than 15 matching carriers were found, click More to see the additional carriers.

c Click the appropriate carrier in the list.

Notes:   • If the carrier does not exist in the system, you might be able to request that it be added. For more information, see Requesting a Custom Carrier. • The selected carrier might change automatically, based on the location of the client or facility. If this occurs, a message advises you of the change.

3 On the right side of the dialog box, respond to the prompts.

The information that you are prompted for varies, depending on the carrier.

Note: If you selected a generic carrier, it might change to a standard carrier automatically after you provide the insurance ID or group number and then press Tab. Certain insurance IDs or group numbers are configured to use a standard carrier rather than a generic carrier.

4 If the lab and client support secondary insurance, and if the patient has secondary insurance, click Secondary in the list in the upper-right portion of the dialog box and then repeat steps 2–3 for the secondary insurance carrier.

Notes:   • If the lab or client does not support secondary insurance, the Secondary option does not appear in the list. • If the primary carrier is a generic carrier, you cannot specify secondary insurance. • 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.

5 Click OK.

6 Do one of the following:

• Use the original lab. If orders for the selected carrier can be placed only with your current lab, that lab remains selected in the Lab list in the Order Details area (if that list appears), and no lab information appears in the Insurance area. Go to step 7.

• Use the primary lab. If the selected carrier uses a different lab as its primary lab, and you can access the primary lab and client, that lab is automatically selected in the Lab list in the Order Details area, the client automatically appears in the Client box, and the name of that lab appears at Defined for in the Insurance area. To use the primary lab and client, go to step 7.

Notes:   • When an order is automatically routed to a different lab, a custom message might appear in yellow below Defined for. • You can change the client. However, if orders for that lab, client, and carrier would normally be routed to a different lab, no additional routing occurs. Each order can be routed only once. • If no SSN or patient ID was specified for the patient, you are prompted to provide that information, and you cannot click Next or complete the order until you do so. Click Edit and type either an SSN or patient ID. • If the carrier is configured to route orders to a lab that you cannot access, or if the defined client is inactive, does not support ordering, or does not support the defined carrier, a message appears in the Insurance area, and the order is not automatically routed.

• Override the original or primary lab. If an Override button appears in the Insurance area and you want to use a different lab, follow these steps:

a Click Override.

A message advises you that choosing a different lab might cause billing issues.

b In the Perform at list, click the lab to use.

The labs that appear in this list vary, depending on how an administrator set up the routing rules and which labs and clients you can access. This list might also include generic labs.

When you choose a different lab, an alert symbol appears in front of the lab listed at Defined for, indicating that the original or primary lab has been overridden. In addition, if a custom message has been defined for the chosen lab, that message appears as well.

If you chose a lab that is a performing site in eLabs, that lab’s name appears in the Lab list in the Order Details area and with the patient demographic information that appears when you click Next. In addition, the defined client automatically appears in the Client box in the Order Details area.

If you chose a generic lab, the original lab and client appear in the Order Details area, the name of the patient’s carrier followed by the generic lab name in parentheses appear in red in the Insurance area, and you will be prompted to complete a generic order.

Notes:   • If no SSN or patient ID was specified for the patient, you are prompted to provide that information, and you cannot click Next or complete the order until you do so. Click Edit and type either an SSN or patient ID. • You can change the client. However, if orders for that lab, client, and carrier would normally be routed to a different lab, no additional routing occur. Each order can be routed only once.

7 Depending on what is appropriate for this order, go to one or more of the following sections:

• Add Attachments

• Add or Edit Guarantor Information

• Add Comments

Note: You can add attachments only if the lab supports this feature, as indicated by the presence of an Attachments button at the top of the Order Entry page.

If you do not have to complete any of those tasks, click Next go to one of the following sections, depending on what is appropriate for this order:

• Verify Insurance Eligibility

• Specify a Diagnosis

• Specify a Test

Notes:   • Eligibility verification occurs only if your user account was configured by an administrator to perform this action, and Bill Type is set to Insurance, and the patient’s primary or secondary carrier has provided eligibility data. • A diagnosis might be required, depending on the client or insurance carrier.