Insurance Verification
This module allows you to verify athlete insurance coverage on both an automated monthly basis and an on-demand basis. With this module you can:
1. Lookup Athletes and their insurance information to see if their coverage is active.
2. Set up monthly verifications for your Athletes to auto confirm policy coverage.
3. Perform on-demand verifications to confirm coverage before sending Athletes out for services
Institution Settings: Insurance
1. From the ADMIN menu, select INSTITUTION.
2. Select the INSURANCE tab.
3. Assign the PRIMARY PHYSICIAN with NPI you want to use to verify your athletes (typically your Team physician).
a. If your Physician is not in SportsWare:
i. Go to the PHONE DATABASE, select an existing Physician and click the UPDATE button to edit an existing Physician or the ADD button to enter a new Physician.
ii. Select “Doctor” from the TYPE of record and fill in at least the NAME and NPI of the Physician you wish to use.
iii. Click the SAVE button and your Physician will now be available as an option.
4. Return to the INSURANCE tab under the INSTITUTION options.
5. Select the Physician in the PRIMARY drop down.
6. You can also set up a SECONDARY Provider. The SECONDARY provider can be the same as the PRIMARY or a different Physician.
7. ENABLE SET ON-DEMAND verifications.
a. Check the ALLOW SET NEXT VERIFICATION DATE TO BE CURRENT option.
8. Click the SAVE button and log out and back in to SportsWare for changes to take effect.
Starting the Insurance Verification Manage
1. From the UTILITIES menu, select INSURANCE VERIFICATION.
2. From the Insurance Verification manager, select an ATHLETE, SPORT, GROUP, or VERIFICATION STATUS and click the LOOKUP button to load the athletes you want to review.
3. SportsWare will load:
a. All Athletes meeting the lookup criteria.
b. The columns with your Athletes’ information pertaining to PAYER, INSURANCE STATUS, LATEST VERIFICATION, NEXT VERIFICATION, VERIFICATIONS LEFT and DETAILS.
4. From the Management screen you can:
a. Add athletes to the Monthly Verification process.
i. Select each eligible athlete individually by marking the check box to the left of their name. Note: You can mark the check box at the top of the left column to select all eligible athletes.
ii. Click the ADD TO MONTHLY VERIFICATION button.
b. Instantly Verify an athlete’s Insurance information
i. Select an eligible athlete, one at a time, by marking the check box to the left of their name
ii. Click the VERIFY NOW button.
c. Review On-Demand verifications
i. After performing an on-demand verification with the VERIFY NOW button, you can click the VIEW VERIFY NOW RESULTS to see the athlete’s verification status.
d. See if an athlete is missing information that will prevent a success verification process
i. To the right of their name there will be if an athlete is missing information that is key to the verification process.
ii. Hover your mouse over the icon to see missing information.
iii. Missing fields: PRIMARY INSURANCE COMPANY, POLICY HOLDER LAST NAME, POLICY HOLDER FIRST NAME, POLICY HOLDER BIRTHDATE, and MEMBER ID.
e. Review Athletes’ Payer name, Payer ID, Insurance Status, Latest and Next Verification, and number of verifications left. The Insurance Status will be:
i. INSURANCE VERIFICATION NOT STARTED: Athletes info has not been submitted (display will be blank).
ii. ACTIVE: The Policy information provided is currently active.
iii. MORE INFORMATION NEEDED: Some of the information needed for verification is inaccurate or missing from the athlete’s profile.
iv. LAPSED: The policy is longer active at the time of verification.
f. Edit Athlete Insurance Details.
i. SportsWare allows you to edit an individual athlete’s insurance information to confirm it is accurate before verification
On-Demand Verification
1. Go to the UTILITIES tab and select INSURANCE VERIFICATION.
a. Search by ATHLETE, SPORT, GROUP, or VERIFICATION STATUS and click the LOOKUP button to load the athlete you want to verify.
2. Confirm they are eligible to be verified
a. You will need to have the following information on file:
i. A PAYER is selected from one of the available options in the drop down.
ii. POLICY HOLDER FIRST and LAST NAME.
iii. POLICY HOLDER’S BIRTHDATE.
iv. MEMBER ID.
b. The following symbol will be displayed in the column to the right of the athlete’s their name if the required information is missing.
i. Hover your mouse over the icon to see missing information.
ii. Missing fields: PRIMARY INSURANCE COMPANY, POLICY HOLDER LAST NAME, POLICY HOLDER FIRST NAME, POLICY HOLDER BIRTHDATE, and MEMBER ID.
3. Click VIEW/EDIT to update an athlete’s profile.
a. Edit fields in order to make profile eligible for submission.
b. Click the SAVE button to return to INSURANCE VERIFICATION MANAGER and verify insurance.
4. Select the check box to the left of their name and click the VERIFY NOW button.
5. Click the OK button to confirm that you want to verify the athlete’s information.
6. Click the OK button to acknowledge the Verification process.
7. You will receive an email with status of the verification for athlete.
8. To review the results:
a. Click the VIEW VERIFY NOW RESULTS button to see the results of the verification for the selected athlete.
b. click VIEW/EDIT to enter the Athlete’s insurance tab.
Monthly Verification
1. From the UTILITIES menu, select INSURANCE VERIFICATION.
a. Search by ATHLETE, SPORT, or GROUP and click the LOOKUP button to load the athletes you want to add to the Monthly verification process.
2. Confirm they are eligible to be verified
a. You will need to have the following information on file:
i. A PAYER is selected from one of the available options in the drop down.
ii. POLICY HOLDER FIRST and LAST NAME.
iii. POLICY HOLDER’S BIRTHDATE.
iv. MEMBER ID.
b. The following symbol will be displayed in the column to the right of the athlete’s their name if the required information is missing.
i. Hover your mouse over the icon to see missing information.
ii. Missing fields: PRIMARY INSURANCE COMPANY, POLICY HOLDER LAST NAME, POLICY HOLDER FIRST NAME, POLICY HOLDER BIRTHDATE, and MEMBER ID.
3. Click VIEW/EDIT to update an athlete’s profile.
a. Edit fields in order to make profile eligible for submission.
b. Click the SAVE button to return to INSURANCE VERIFICATION MANAGER and verify insurance.
4. Select the check box to the left of the names and click the ADD TO MONTHLY VERIFICATION button.
5. Click the OK button to acknowledge adding selected athletes to the Monthly verification process.
6. Click the OK button to confirm Monthly Verification request.
7. The results for your athletes’ verifications will be available approximately 24 hours after being added.
Verification Results
1. Verification results are displayed in the INSURANCE VERIFICATION MANAGER and in an individual athlete’s profile.
a. Insurance Verification manager
i. Review by selecting ATHLETE, SPORT, GROUP, or VERIFICATION STATUS and click the LOOKUP button to load the athletes you want to review.
ii. Overview of the athlete’s information
i. Click VIEW/EDIT to review specifics of each athlete.
b. Athlete’s Profile
i. Go to your ATHLETE DATABASE or the INSURANCE VERIFICATION MANAGER.
ii. Search for the athlete and click the UPDATE or LOOKUP (if in INSURANCE VERIFICATION MANAGER) button.
iii. Review the INSURANCE tab as results will be the bottom.
2. Insurance Verification Results.
a. Status:
i. ACTIVE: The Policy information provided is currently active.
ii. MORE INFORMATION NEEDED: Some of the information needed for verification is inaccurate or missing from the athlete’s profile.
iii. LAPSED: The policy is longer active at the time of verification.
b. LAST VERIFICATION DATE: Date information was last verified through SportsWareOnline.
c. VERIFICATIONS LEFT: Remaining verifications left for the athlete.
d. Yes or No coverage for:
i. HEALTH BENEFIT COVERAGE
ii. MEDICAL CARE
iii. EMERGENCY
iv. URGENT CARE
v. HOSPITAL
vi. OFFICE VISIT
e. Click the Arrow next to ACTIVE to review all status information.
i. Active policy.
ii. Lapsed policy.
iii. More Information Needed.
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