Guide to Extended Health Benefits Tracking

This guide explains how to use Universal Office to record and track benefit schedule usage for every patient with Extended Health policy coverage.

To begin, enter the policy information:

1. Open Patient Manager.
2. Locate and select a patient with an EHC, WSIB, Slip & Fall, or MVA case.
3. Next, select the case.
4. Under the Claims section, click on the three-dotted button next to Primary EHC.
5. In the EHC Details window, click [New Coverage] on the toolbar.
6. Start to type the name of the insurance company in the Insurance Co field, and the system autocompletes the entry as you type it. If necessary, select an insurance company from the options in the drop-down list.
7. Select the billing address from the Billing Address drop-down list.
8. Select a relevant claim form from the Claim Form drop-down list.
9. Enter the policy number and the certificate ID into the corresponding fields.
10. If the plan member is the patient, check the Same as patient box; otherwise, enter the First and Last name of the policyholder, and select the policy holder’s date of birth (DOB).
11. Finally, click [Save Coverage] on the toolbar.

Next, capture the available coverage, including details.

1. While in the EHC Details window, open the Benefit Schedule Details tab.
2. Click [New Coverage] on the toolbar.
3. Confirm that Service is selected in the Benefit Type drop-down list, and the Start and End Date are accurate for the coverage period.
4. From the Description drop-down list, select the type of service to be added (for example, Physiotherapy).
5. Enter the maximum coverage amount into the Maximum Amt field or check the Unlimited box, and then enter the coverage rate, paid receipt requirement, record deductible visits, dollar value of service used elsewhere, and add comments.
   Note: If every visit is fully covered, enter 100% in the Coverage Rate field.
6. Click [Save & Close].
   Repeat steps 2 – 6 for every service and product available in the patient’s benefits schedule that you want to keep on record. In some policies, the products (assistive devices), such as orthotics, are renewable at a two-year interval. Confirm that the Start and End Date are accurate for the coverage period.
7. Once you are finished, close the EHC Details window.

Once you add the coverage details, create a treatment plan based on that coverage information.

1. Open the Documents tab in the patient’s case.
2. Click [New Document] on the toolbar.
3. From the Template type drop-down list, select EHC Plan, and then click [Open].
4. Enter a plan description into the Plan Name field (Basic Physiotherapy, Cognitive Physiotherapy, and so on).
5. In the Providers table, click inside the Provider column to activate the drop-down list, and then select one or more providers as required.
6. Next, click inside the EHC1 column, and select a service type.
   Note: If a patient has a secondary policy that covers the same service selected in the EHC1 column, you may also select the EHC2.
7. Check the box in the PP (Primary Provider) column beside one of the selected providers.
8. In the Services table, click inside the Item ID column and select one or more services using the drop-down list.
9. Select the provider reference using the drop-down list available once you click inside the PR column.
10. Enter total number of visits under the Qty column, and then check the box in the EHC1 (and/or EHC2) Coverage Info.
    Note: The amount displayed under the Available column in the Benefits Type table is reduced by the amount used in the Services table. You may adjust the Qty and the Service Rate (located under the Msr Rate column) as needed.
11. Finally, indicate the duration of the treatment plan by entering a number into the Duration in weeks field (top-right of the window), check the box next to Start Date, pick a treatment plan start date, and then click [Calculate Plan End Date].
    Note: Having a plan end date helps remind you of patients who fail to fulfil treatments prescribed in the treatment plan.
12. To save the treatment plan, click [Save & Close] on the bottom-right of the screen.

The next step in the tracking process is scheduling and charging visits.

1. In the Appointment Book, click [New Appointment & Precharge] on the toolbar.
2. From the Patient name drop-down list, select a patient.
3. From the Case No. drop-down list, select the appropriate case.
4. Make sure that EHC is selected in the Charge type drop-down list.
5. From the Plan drop-down list, select the plan you have just created.
   Note: The remaining quantity of visits on this plan is displayed under the RQty column for every service proposed in the plan.
6. Select the appointment information such as Appointment date, Scheduled provider, Scheduled activity, Duration, and Start time.
7. Check the box next to the service for which you want to add a charge.
   Note that the remaining quantity, under the RQty column, for the service is reduced by one (1). Therefore, you know how many visits are remaining before you schedule an appointment by the treatment plan.
8. Click [Save & Close].

In cases where you help patients complete the insurer claim forms, you can create them right in the patient’s file, as the system prefills all information already available.

1. Open the Documents tab in the patient’s case.
2. Click [New Document] on the toolbar.
3. From the Template type drop-down list, select EHC1 – (or EHC2 – ), and then click [Open].
   Note: The patient name and policy information on record is used to prepopulate the claim form.
4. Use the links on the left to complete the different parts of the claim form.
5. Click [Preview].

When you use Universal Office to record and track Extended Health Benefits, you gain valuable insight into your business data.

From the variety of information you can extract from the system, the following are the most common reports used in facilities across Ontario.

Patient List with EHC Coverage: This report lists patients with Primary and/or Secondary EHC coverage, regardless of case type.

Patient EHC Benefits Schedule: This report lists patients with Benefit Schedule coverage details for every case.

EHC Treatment Plan Remaining Quantity: This report lists EHC Plans with the current count for remaining visits.

Patient visits by Primary EHC: This report lists patients with checked-in appointments grouped by their primary insurer. The total count of the checked-in appointments is summed up and displayed at the end of the list.

MVA Patients with EHC Coverage: This report lists all MVA patients with primary and/or Secondary EHC coverage.

At the end of every year, it’s time to confirm that the benefits for patients with Extended Health insurance are renewed and ready to be used for the following year. In this section, learn the steps to renew benefits for all patients at once.

1. Open Patient Manager.
2. Go to File > EHC Batch Renew.
3. Check the Select All box or check only the box beside an individual patient case.
4. Choose next year from the Renew selected items for drop-down list.
5. Click [Renew & Close].

The system renews selected cases and returns to the Benefits Schedule Renew Batch Manager.