Setting up Insurance Benefits

After a client is admitted to the program, it is time to set up insurance benefits in SAMMS.

• Click on the Third Party tab in the client file .
• Click on the current payer from the Payers screen.
• The Payer Enrollment screen will display.
  

• If the client’s Insurance ID Card has not yet been scanned, do so now.
• Make sure that all the information that was previously entered is accurate.
• Based on the information on the Insurance ID Card, and the Eligibility, Coverage, or Benefit Report that was generated, add or update patient responsibility in the boxes on the right side of the screen.
• Plan Deductible will be indicated on the Insurance ID card as an annual amount. For example, a Plan Deductible might be $1000.00 per year. Enter that dollar amount in numerals only.
• Current Deductible is the amount of deductible remaining for the year. If a client has already paid $400.00 of a $1000.00 deductible, the Current Deductible would be $600.00. Find the Current Deductible amount on the Eligibility, Coverage, or Benefit Report and enter the dollar amount in numerals only.
• Copay is the dollar amount that a client must pay at each visit, normally a set fee. A typical Copay might be $30.00. Enter the Copay dollar amount in numerals only.
• Coinsurance refers to a percentage of fees that are the client’s responsibility, after the deductible is met. For example, an insurance policy may cover only 80% of medical fees. In that case, enter the numeral 20 in the Coinsurance box to reflect the remaining 20% patient responsibility.
• Click on Set Up Billing Based on Benefits and Save.

!When patient responsibility information is saved in SAMMS, the system will be set up to determine the amount of money the patient must pay at each visit. It will update automatically.