| Payor | Enter the Payor Name that normally has primary responsibility for the customer’s claims. | ||||||
| Policy Number | The insured person’s insurance policy number. | ||||||
| Insured Name, Address and Phone Number | The insured person or policyholder’s name, address and phone number. | ||||||
| Birth | The insured person’s date of birth. | ||||||
| Gender | The insured person or policyholder’s gender. | ||||||
| Relationship | The insured’s relation to the customer. | ||||||
| Group Name | The insured person’s insurance group name. | ||||||
| Group Number | The insured person’s insurance group number. | ||||||
| Reserved for Local Use | Enter any information which should be printed in “Reserved for Local Use” on Claim forms for this Policy. | ||||||
| Policy Type | Enter the Policy Type of the Policy.This will default from the Payor you choose. | ||||||
| Assignment |
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| Responsibility 1st%/ 2nd% | What percentage of allowable will the insurance payor pay as primary or secondary. See How To Setup Responsibility Percentages | ||||||
| Effective From/Thru | The effective dates of the insurance policy. User will receive a warning message if attempting to bill an expired policy. | ||||||
| List Order | Choose the order in which you want the payor displayed when placing an order.Note: You can change this in the order as well, so this should be the default order. | ||||||
| Active | Check if policy is active. If not active, the system will give you a warning message when billing Clams for this policy. | ||||||
| Default | Check if policy will be automatically added to new orders for this customer. This is a read-only field checked when list order is 4 or less. | ||||||
| EPSDT | Check if this policy is an Early & Periodic Screening, Diagnosis, and Treatment policy. | ||||||
| Hold Reason | Enter any reason to hold Claims for this policy. | ||||||
| Scan | Click the scan button to attach an image of the customer’s insurance card. See Scanner EditNote: Policy must be in edit mode to attach an image. |
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