Reading an Insurance Card
If you’re thinking of joining an insurance panel for the first time, or you have already completed the credentialing process and are ready to start accepting patients with insurance, you will need to understand how to read an insurance card, and the important information that is contained on those cards. In this article, we will go over some of the common things included on an insurance card and what they mean, as well as some helpful tips on collecting insurance information from your patients.
Collecting the Information
The first step in reading an insurance card is collecting that insurance card from your patient! We recommend that you make a copy of the front and back of the patient’s insurance card as part of the patient intake process. If possible, upload that information into your patient’s record in your EHR. We know for sure that TherapyNotes has this feature, and it’s one of our favorites. Having the insurance card on file can be helpful if you run into rejections, since you can double check all information on the claim to the information on the card.
Front of the Insurance Card
All insurance companies format their information a little bit differently, however there are a few things that are typical across many insurance companies. We will be describing the most common instances, but keep in mind you may come across insurance cards that vary slightly in their information represented. The front of the card contains details specific to your patient, or the insured.
The name of the insurance plan will be included on the insurance card. Be sure to note any specific subsidiaries of the insurance company so that you are submitting claims to the proper place. For example in Michigan, there is Blue Cross Blue Shield, and then there is Blue Care Network. Both cards look very similar, so it is important that you note if there is any distinction.
Patient Name or Named Insured
The first piece of information that you should gather from the card is the name. Make sure that you have the spelling of the name of the card holder correct. Also make sure that you note the “named insured” if there is one. This would often be a parent or a spouse, and knowing the relationship of your patient to the named insured is also important. This may not be listed on the card, but you can ask your patient to clarify. Look for any other personal identifiers of the patient that may be on the card, including date of birth.
Insurance ID Number/Enrollee ID
The next piece of information that you need from the insurance card is the patient’s ID number. This number is issued by the insurance company, and identifies the patient and their insurance policy. These numbers will be unique per insurance policy. If you are using an EHR, this number should be entered into the patient’s record. Unless your patient is a private pay client, they should always have an ID number/Enrollee ID.
Insurance Group Number
This number only applies if your patient received health insurance through their employer. Employees of the same company plan will have the same group number. This number tells the insurance company which group plan the patient is a part of. If you are using an EHR, this number should be entered under the Group Number field, but if there is no group number this can be left blank.
Back of the Insurance Card
The back of the insurance card contains valuable information for you as well, though this information is more specific to the insurance company rather than the insured. On the back of the card, you can usually find information pertinent to submitting claims.
Insurance Contact Phone Number
The back of the insurance card will typically have a phone number that you can call if you have questions about the patient’s insurance, or if you have questions about the claim submission process. If you can, enter this phone number into your EHR system under the payer so that you have the phone number on file. There may be multiple phone numbers on the back of the card, each with a different purpose. Be sure to identify the phone number that is most relevant to your inquiry to avoid phone transfers and confusion.
If you are submitting paper claims, this is the address that you would submit the claim to. Noting this address in your EHR system for a payer can be helpful if you do ever find that you need to submit paper claims. Note that the claims address may be different from the address for things such as credentialing or general correspondence. In some cases, the back of the card may instruct you to reference your contract for instructions on how to submit claims. If you don’t have your contract readily available, you can always request a second copy from the insurance company. This is something that we highly recommend you keep on file in a safe yet easily accessible location.
Sometimes, the back of the insurance card will call out the Payer ID for the insurance company. This is especially important for submitting electronic claims. Let’s return to the example mentioned earlier of Blue Cross Blue Shield of Michigan and Blue Care Network. While they share a single website, each of these entities has its own payer ID when it comes to submitting electronic claims. Having the proper payer ID identified is extremely important when getting set up for EDI and ERA, so if the back of the insurance card includes this it’s great! If it does not include the payer ID your clearinghouse should be able to provide it to you. The claims address can be helpful in identifying the correct Payer ID.
Getting Updated Insurance Cards
Every time that you see your patient, you should inquire as to whether or not there have been any changes to their insurance. You may even have a record of an expiration date on the card to know if the information you have on file is outdated. Any time that the patient knows there has been a change, you should request their new card, and make a copy. Be sure to make note of which is the old information and which is the new information.
Collecting and understanding all of the information on an insurance card is a great first step to submitting claims. Having the information on file to reference can be a great help when it comes to insurance billing. If you would prefer to collect the cards and let someone else step in to take care of the billing, Practice Solutions can help! We offer full service billing, and can be reached at www.practicesol.com, 734-437-9432, or firstname.lastname@example.org if you would like to find out more.