How to Define a Copayment or Coinsurance

Note: This feature is only available to users who have the Claims module enabled.

Setting the Client as an Insurance Client

When you see an insured client you will typically want to bill their copayment amount via IntakeQ. In order to tell IntakeQ to invoice these clientsonly for their copays, there are 2 necessary steps:

First, in their client profile, change their "Billing Type" field to "Insurance":

Further down in the same screen, set their copay amount:

Like other client profile fields, the copay can be mapped to intake forms in case you want to collect this information during your intake process.

In order to bill the copay for an actual session, open the session's appointment dialog, and in the Invoice field click on "Actions" to see the invoice creation shortcuts.

Notice that the invoice will be created with the information pulled from the client's profile "Primary Insurance Copay" field.

Recording a Coinsurance

There is also a field for recording a coinsurance. If a coinsurance is entered, the defined percentage of the allowed amount from the insurance company will be used to determine the patient responsibility when creating the invoice, NOT the copay.

1. Go to a client profile and click the "Edit" button in the top right
2. Scroll down to the Insurance section and input the coinsurance percentage according to the clients plan
3. If a coinsurance is entered, you will see a ⚠️ icon. This is just to tell you the copay will not be used if a coinsurance is entered:
4. You can also set up different coinsurances by code. View more about how to do that here.

IMPORTANT: Allowed amounts for the payer must be entered for the coinsurance feature to work. These can be entered in the payer settings. If no allowed amount is entered and a coinsurance is defined, you will receive a notification that the coinsurance will not be applied because no allowed amount is set.

Disabling the Coinsurance

You can disable the coinsurance when not it use and your coinsurance value will still be saved in the client's profile so you don't have to remember the coinsurance value once the client has met their deductible for the year and the coinsurance comes back into play:

1. Go to Lists > Claims > Claim Settings > Payers > Edit Payer and scroll down to the bottom to add allowed amounts by code for the payer. You can set the CPT code and the allowed amount:
   
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Invoices and Coinsurance

The invoice will reflect the resulting amount of taking the coinsurance percentage from the allowed amount for the CPT code under that.