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
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:
Search for the diagnosis name or code.
Select the appropriate DX Code.
The start date will default to today’s date; adjust it if necessary.
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/Nickname: Start typing the first three letters of the Payer Name for the dropdown payer list to populate.
Primary or Secondary Coverage: Choose appropriately.
Coverage Start Date and End Date: Set based on insurance verification.
Member ID Number and Claim Number: Enter as shown on the patient's insurance card.
Group Identifier: Enter if available from the insurance card.
Plan Identifier or Prior Authorization Number: Optional.
Policy 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 (Optional):
Deductible: Enter if applicable.
Co-Pay Amount: Enter if applicable.
Maximum Visits: Enter if needed. A notification will appear on the doctor’s SOAP note screen when the limit is reached.
📌 For detailed instructions and step-by-step guidance on these Patient Responsibility Amounts (video included), please refer to our Knowledge Base Article on "New Copay Paradigm" here.
Additional Information:
Enter Date of Illness/Injury and Qualifier if applicable.
Accept Assignment will default to "Yes."
Referring Provider:
If required by the third party payer, the referring provider must be entered.
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.
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 detailed instructions and step-by-step guidance (video included), please refer to our Knowledge Base Article on "Default Services" here.
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.
Rename the Case: 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.