This guide will walk you through the full process of setting up an insurance case and the related policy in ChiroHD.
Step 1: Create the Insurance Case
Access the Patient Profile.
Search for the patient using the search bar.
OR click on their name on the calendar.Click on the Cases tab, and click Create New Case.
Choose from the dropdown menu, Insurance Case Type.
Select Bill Normally and leave other options at their defaults.
Click Save Changes.
Set the newly created Insurance Case as the patient's default case by clicking the push pin icon.
Step 2: Enter Diagnosis Codes (DX Codes)
Open the Insurance Case.
Go to the Treatment DX Tab.
Add DX Codes.
Add Diagnosis Codes by clicking in the Add code to case.
Choose the Start Date (It will default to today’s date).
Save Changes.
Tip: If you backdate the first DX code, subsequent codes will use the same start date automatically.
Step 3: Add Insurance Policy Information
Go to the Coverage Tab.
Click Add New Insurance Coverage.
Fill Out the Coverage Form:
Third Party Payer: The name of the insurance company responsible for processing and paying claims for the patient’s coverage. Start typing the first three letters of the payer name to select from the pre-created payer list.
Nickname: An optional internal abbreviation or custom name used by the office to easily identify the insurance policy or payer; this field does not populate on the HCFA claim form.
Priority: Indicates the order in which insurance policies are billed for the patient’s claims, such as Primary or Secondary coverage.
Coverage Start Date: The date the insurance policy coverage becomes active and eligible for claims. Set based on insurance verification.
Renews on: The date the current insurance policy term ends and the coverage is scheduled to renew or be updated for the next policy period.
Coverage End Date: The date the insurance policy coverage expires or is no longer active for claims processing. Set based on insurance verification.
ID/Claim Number (Box 1a): Also known as Member ID. Enter as shown on the patient's insurance card.
Group Identifier (Box 11): A number or code assigned by the insurance carrier to identify the employer group, organization, or plan associated with the patient’s insurance policy. Enter if available from the insurance card.
Plan Identifier (Box 11c): Optional. n optional code or name used to further identify a specific insurance plan or benefit package associated with the patient’s policy. Information would be found on the patient's insurance card.
Prior Authorization Number (Box 23): Optional. Information would be obtained from the insurance company who requires the prior authorization.
Notes: Optional, for any internal notes.
Relationship to Insured:
If the patient is the subscriber, select Self.
If insured under a spouse or parent, select the relationship and enter the subscriber’s information.
Patient Responsibility Amounts (Recommended):
Remaining Deductible
Purpose: Enter the amount the patient has remaining to meet their deductible after performing an eligibility check.
Important Note: This amount does not automatically adjust as services are added to the ledger; it must be manually updated. If an EOB indicates that a patient has met their deductible, delete the remaining deductible amount to enable the co-insurance percentage.
Fee Schedule: If attached, the allowed amount is applied to the deductible column. Without it, the full charge amount is applied.
Copay
Purpose: Specify the copay amount and number of visits where the copay will apply toward patient responsibility.
Co-insurance %
Purpose: Enter the patient’s co-insurance percentage (e.g., for an 80/20 split, enter 20).
Fee Schedule: If attached, the patient’s percentage is calculated based on the allowed amount. Without it, the full charge amount is used.
Max Visits
Purpose: Enter the total number of visits allowed based on the patient’s policy.
Notification: Once max visits are reached, a message will appear on the SOAP notes screen. It is recommended to set up an alert for the front desk as well.
Tracking: The "Max Visits" field references the patient's ledger and counts any service categorized under "Chiropractic" in the Tracking/Reporting tab. To access this, go to:
Path: System Dashboard > System Settings > System Configuration > Tracking/Reporting > Chiropractic.
Automation: After max visits are reached, the system will set subsequent services to be fully patient responsibility, excluding them from the billing queue.
Date of current illness or injury (Box 14): The date the patient’s current condition, illness, injury, or symptoms first began or occurred.
Onset Qualifier: 431 - Onset of Current Symptoms or illness
Box 19: Optional additional notes box
Billing Provider Other ID (Box 33b): Optional. Is used to enter the billing provider’s secondary identification number, if required by the payer. Box 33b mainly comes up when an insurance payer requires an additional provider identifier besides the NPI, such as a legacy ID, taxonomy-related identifier, or payer-specific provider number.
Accept Assignment: Indicates whether insurance payments are sent directly to the provider or to the patient. If selected Yes, payment is sent to the office; if selected No, payment is sent to the patient.
Referring Provider (Box 17): Used to enter the name of the referring, ordering, or supervising provider associated with the patient’s care or services rendered.
Check for Missing Patient Information:
A red warning will appear if key patient information (e.g., gender, birthdate) is missing.
Click Edit next to the patient's information and complete the missing fields.
Click Save.
Step 4: Set Up Default Services (Optional)
Under Default Services tab, select services that will automatically populate on each SOAP note for this case.
Click Save Changes.
For more information and detailed instructions and step-by-step guidance please refer to our other resources on Default Services.
Step 5: Additional Tabs in Patient Cases
Transactions Tab:
View the transactions specific to this insurance case.
Settings Tab
Suspend Billing: Used primarily for PI (Personal Injury) cases where billing should be delayed until settlement.
Edit Case Name: Adjust the Case Name if desired (e.g., “Insurance 2024").
Change Case Type.
Set Default Calendar Provider and Default Billing Provider for this case.
Important Reminders
Third Party Payers must be set up first before creating an insurance policy.
Insurance Cases should not be confused with Cash, Medicare, Work Comp, or PI Cases — ensure the correct case type is selected.
Setting Max Visits only triggers a doctor-side alert; for full visibility, also set a patient alert for the front desk and billing team.
Always validate patient demographic information during setup to prevent claim rejections.