What is Unknown Insurance?
An "unknown insurance" occurs when a payer does not exactly match any existing payer in your system’s payer list.
Why Does This Happen?
There are four common causes of unknown payers:
Manual Entry Errors: A staff member typed an insurance name instead of selecting it from the dropdown list while creating the patient, case, or appointment.
Patient-Provided Details: The patient entered this payer during the digital intake process.
Payer List Changes: The payer name or ID was modified in the system, causing a mismatch.
Claim Imports: Claims imported from another system do not align with the current payer list or payer IDs.
How to Correct Unknown Insurance
To resolve unknown insurance issues, follow one these steps:
Update Patent Profile
Update Patent Profile
1. From the patient profile click "Insurance"
2. Click "Actions"
3. Click "Edit"
4. Select a known payer
5. Click "Save"
6. Navigate to the claim, click "Claims"
7. Once the applicable claim is selected, click the insurance section
8. Click "Edit"
9. Click "Sync with Insurance on File"
10. Click "Sync" - This will pull the information used in the patient profile
Update from the Claim
Update from the Claim
1. Select the applicable claim
2. Click Insurance
3. Click Edit
4. If applicable update member ID
5. Click the Payer
6. Select from the known payer list
7. Click "Save Changes"
8. Click "Update" - This will update the patient profile and all future claims
