Change an Employer Policy

Scenarios:

1. Your patient is ready to start Phase II, and has new insurance. You need to update thier insurance on file in Tops.
2. Your patient started treatment with one insurance, but now the policy holder has new job and you need to change the insurance mid-treatment.
3. Your patient has had a slight change in their insurance. They have new insurance coverage with their same employer. It's the same insurance company, but a different group number.
4. Your patient no longer has active insurance and you want to remove the existing policy and employer policy from their chart.

Sound familiar?

In Scenarios 1-3, they all can be treated the same. By using Change Policy Holder, a new policy holder and employer policy relationship should be established. In scenario 4, you simply choose Clear Policy Holder.

Here's how to add change the policy on the patient's Tops Ortho chart:

In a nutshell, any time a patient has new insurance, you will use the Change Policy Holder option from the Policy Holder window to remove the entire, linked Policy Holder and Employer Policy record from the patient's chart. You then add a new policy holder record and new insurance to the patient's chart.

Even if the policy is no longer active, keeping the previous policy holder and employer policy details linked is important for data integrity. By changing the policy holder, Tops removes the policy holder and employer policy details from the patient's chart, but Tops still keeps the relationship intact. You can locate the past policies no longer linked to patients through Matrix>Policy Holders. Think of the policy holder and employer policy relationship like a folder. The data from both records populated claims that were associated with the policy. You don't want to separate them!

Below is an example of how to treat Scenario 1 (which as a reminder, is how you would also treat scenario 2 and 3!)

Our example patient, Humberto, has a Tops Ortho chart and was seen for treatment as a Phase I patient. His father, Ignacio, is entered as the policy holder in Insurance 1, and had a Cigna policy through his employer, Walmart. Humberto has been in Observation for the past couple of years, and now is ready for Phase II. During the re-verification of insurance, the insurance coordinator learns that the Cigna policy is no longer active. Ignacio indicates he has a new policy with Delta Dental at Walmart. What do you do?

1. Ignacio's policy holder record and employer policy record with Walmart/Cigna should not be separated, as the details are historical, and were used to populate claims in the previous phase.
2. To the left of the current policy holder's name, select the delta icon and choose the option to Change Policy Holder.
3. Search for Ignacio's name. Do not select his existing policy holder record, as you are creating a new policy holder record. You want to create an entirely new Policy Holder record for Ignacio reflecting his new policy number unique to Delta Dental. You'll then attach the corresponding Employer policy.
4. Follow the instructions on finding an existing Employer Policy or adding a new Employer Policy in the article referenced at the bottom of this page.

Why locking the details is important

Insurance Company details in the Employer Policy record - along with Employer details - should be locked once they are created or corrected.

Any changes made to the Employer Policy record will affect all patients who have ever used the policy. This includes patients whose policy is no longer active.

If an employee:

• Changes groups within the same insurance company
• Changes insurance providers within the same company
• Changes jobs and obtains new insurance

If an employee’s insurance changes, you must:

• Create a new Policy Holder record
• Either link the new policy holder to an existing Employer Policy record, or create a new Employer Policy record if one does not already exist

Think of the Policy Holder and linked Employer Policy record like an insurance card. When someone receives new insurance, they do not alter their old card — they receive a completely new one.

The original Policy Holder and Employer Policy relationship must remain unchanged to preserve historical accuracy. Existing claims are tied to the original policy details, and modifying those records can impact all past claims associated with that policy.

For more information, reference the article below Change Employer Policy.