Overview of Insurance (3rd party payment)

This Article was written before WINK integrated with Telus Health.  The assumption is that the client is tracking the amounts owed by 3rd party payers and records the payments made by the 3rd party payers.

This Article would apply to any WINK user who is NOT using Telus Health through WINK, and also to 3rd party payers who are NOT part of the Telus Health group of insurers. 

It does NOT apply to provincial medical care claims.

Here are two videos which explain the two parts of the process:

(Go to 19th minute):  https://www.youtube.com/watch?v=4l5gdskqjAA&list=PLwlTTFA5xL1FN7T-Y5qjmyBOdSgf8SMoK  This video shows how to set up an insurance carrier as a Supplier in WINK.

https://www.youtube.com/watch?v=ba41MChR-ik&list=PLwlTTFA5xL1Gi04YrrLJ2x-hzm4AjOGHW  This video explains how to enter insurance and co-pays on an invoice, and how to record payments from insurers to accurately track the payments and any charge backs applied.

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Here is the process for inputting insurance payments (or any other 3rd party payments) into Wink.

PRELIMINARY SETUP:

1. Create a supplier account for each insurance company (3rd party payer) that you accept in your practice (or if you don’t want to track your payments due, simply create one called “Insurance”)
1. Make sure to check off the “Insurance Company” check box
2. Don’t forget to insert your account number, and to assign it to your store as well.

AT THE POINT OF SALE:

1. Create your invoice / worksheet as you normally would.
2. On the invoice itself, select the appropriate insurance company.
3. If the insurance requires that you "discount" the patient's purchases, then enter the amount of discount in the column for discount.
1. If you cannot figure out how much of a discount to give, then you can skip this step.
4. In the patient column, enter the amount that patient will be paying for each item (his "Out of Pocket" expenses). The balance due will automatically be transferred to the insurance column.
1. (Unit Price - Discount - Patient Out of Pocket Expense) = Insurance Remittance.
5. If a deductible (Copay) is required, then add it to the invoice in the same way as you might add any other service by typing the word "Co Pay".
6. Enter the Copay amount in the "Patient" column.
1. Whichever amount you enter in Copay-patient cell will automatically be deducted from the Copay-Insurance cell.
7. Receive the payment from the patient as you would any other invoice.
8. You have the option of printing / emailing an invoice with or without insurance details appearing on it.  If you were not able to figure out how much of a discount to give your patient, or you were unable to determine what your final insurance remittance will be, then we highly recommend that you print the invoice "WITHOUT" insurance details.
1. (In other words, the only information you really need to enter on the invoice is the patient "Out of Pocket" expense.  WINK will figure out the rest for you later)
9. Close the window.
10. When your patient returns to your practice to pick up his frames/lenses, you can collect the balance due from patient and close the job, as you would any other invoice.

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As you are not signed up with any Wink Integrated Insurance clearinghouse (ex: Gateway EDI, Telus Health), you must now submit your payment to your insurance company manually. When you finally receive payment from that insurance company, you must enter that payment received from insurance.  For the sake of argument, we are going to assume the insurance company is paying you by cheque. Here then is the process for receiving a payment from insurance:

RECEIVING PAYMENT FROM INSURANCE:

1. Click on “Insurance Payments”
2. Click on “New”
3. Select the insurance provider
4. Enter your cheque number in the field "Reference"
5. Click on the "Unpaid Claims" tab
6. Select and “right-click” on the patient you’ve received a payment for.
7. Select “Add to Payment”
1. You can add multiple patients on the same receipt, by cycling back to the "Unpaid Claims" tab. The objective is that the document you are creating now should be "identical" to the statement which accompanied the chequek from the insurance company / 3rd party payer.
8. In the 4th column from the right (where the insurance company name appears) enter the correct amount that you received from the insurance company. Next click on the blue arrow located between the 2nd and 3rd columns (from the right). Do so for all items all the way down.
1. Notice that if your insurance company remitted a different amount to you than originally expected, WINK will automatically transfer that difference to the column "discount".  This is why you didn't need to figure it out on the invoice at the time of sale.  WINK just automatically reconciles the amount for you when you receive the payment from insurance.
9. If your insurance payments are subject to lab chargebacks, and you have entered your lenses as "Received" via "Product Receive/Transfer", then your lab chargeback will appear here AUTOMATICALLY. You can then skip to #10 below.  Alternatively, here is the process for MANUALLY deducting chargebacks from insurance payments:
1. Click on “Add Lab Chargeback”.
2. Type the name of the lens in the first field, and select the appropriate product.
3. Type the price you paid.
4. Select the appropriate tax code if required.
5. Click on “Add Chargeback”.
10. To confirm the lab chargeback amount, click on the blue arrow as you did in step 6 above.
11. Add any additional comments or upload any documents you wish.
12. The total at the bottom right of the window should be "exactly equal to" the amount on the cheque which you have received from the insurance company.
13. if it is, click Save >> click Close.

Job Status:

Return to the Rx Worksheet for the patient, and click on the tab "Job Status". Notice that if you are following the steps above, WINK is tracking your job for you. Furthermore if integrated with your lab, many of the steps described above are done automatically.

Reports:

To understand the financials, you can generate two separate reports:

1. Patients >> Payment Received >> Details
2. Insurance >> Payments Received