Insurance Verification User Manual

 

Welcome to the SportsWareOnLine Insurance Verification module. This tool simplifies your workflow by automating insurance checks and providing real-time coverage data.

 

 

 

With this module, you can:

 

• Verify athlete insurance status in seconds.
• Automate monthly policy checks for your entire roster.
• Confirm active coverage on demand before providing services.

 

 

Let’s get started!

 

 

 

 

 

 

 

 

Configuring Institution Insurance Settings

Before you begin verifying coverage, you must configure your institutional settings to identify the authorizing provider.

1. Access the Insurance Menu

·         Navigate to the ADMIN menu and select INSTITUTION.

·         Click the INSURANCE tab to open your configuration options.

2. Select your Team Physician from the drop-down (if your team physician is not available in the drop-down menu, go to the phone database, to add see instructions below)

Note: This is typically your Team Physician.

 

 

 

If your physician is not in SportsWare:

 

Go to the PHONE DATABASE.

Click ADD to enter a new physician to the phone book.

 

Choose ‘Doctor’ as the TYPE when adding from the drop-down menu and fill in the screen fields. You must complete the Doctors full name and NPI number for the record.

 

Additional Insurance Settings

To complete your configuration, navigate from the PHONE BOOK back to the INSURANCE tab and update the following:

1.    Secondary Provider: Select an additional provider if needed (Primary and Secondary can be the same).

2.    On-Demand Access: "Allow Set Next Verification Date to be Current" to YES.

Note: To finalize these updates, SAVE your changes and restart your session (log out and back in).

Starting the Insurance Verification Manager

To begin managing your athlete coverage, navigate to the UTILITIES menu and select INSURANCE VERIFICATION.

1. Filter and Search

Use the Athlete Insurance Verification Management screen to narrow down your list. You can filter by Athlete, Sport, Group, or Verification Status. Once your criteria are set, click the Apply Filter button.

Enrolling Athletes in Monthly Verifications

To add athletes to the monthly verification:

·         Select the athletes to be added to the monthly verification by clicking the box to the left of the athlete’s name.

o   Tip: To select all athletes in the list at once, click the checkbox at the very top of the column.

·         Activate: Click the ADD TO MONTHLY VERIFICATION button to enroll the selected athletes in the automated monthly cycle.

Reviewing the Results (Results are returned the next day)

SportsWare will generate a list of all athletes matching your filter. The results screen provides a comprehensive overview of:

·       Insurance Status: Active, Lapsed or More Information Needed.

·       Timeline: Dates for the Latest and Next scheduled verifications.

·       Remaining Verifications: The number of Verifications Left for that athlete.

Performing On-Demand Verifications

If you need to confirm coverage for an athlete immediately, for example, before a same-day consultation or test such as an MRI—you can perform an "on-demand" verification.

1.     Select the Athlete: In the results list, find the eligible athlete you wish to check. Click the checkbox to the left of their name.

                  Note: On-demand verifications must be performed for one athlete at a time.

2.     Verify Coverage: Click the VERIFY NOW button.

Reviewing and Troubleshooting Verifications

Once you have performed a lookup or an on-demand check, use the following tools to review results and resolve errors.

1. Viewing On-Demand Results

After clicking the VERIFY NOW button, you can immediately review the outcome:

·         Click VIEW VERIFY NOW RESULTS to see the real-time status of the athlete’s coverage.

2. Troubleshooting Missing Information

If an athlete is missing data required for a successful verification, a Warning Icon (!) [or describe icon] will appear to the right of their name.

·         Identify Errors: Hover your mouse over the icon to see a listing showing the missing fields.

·         Required Fields: The system will not give you the option to request a verification if any of the below fields are missing:

o    Primary Insurance Company selected from the payer drop-down menu, Member ID, and Policy Holder Name (First/Last) and Birthdate.

3. Understanding Insurance Statuses

The Insurance Status column will display one of the following results after a verification attempt:

·         [Blank]: Insurance verification has not been started for this athlete.

·         ACTIVE: The policy information provided is confirmed as currently active.

·         LAPSED: The policy was found to be no longer active at the time of verification.

·         MORE INFORMATION NEEDED: The verification cannot be completed (see explanation for failure displayed on the screen).

4. Editing Athlete Insurance Details

If you need to correct information before re-verifying:

·         Click the Athlete’s Name directly from the listing screen.

·         This opens their profile, allowing you to update insurance details and save changes without leaving the Verification Manager. Click SAVE.

Please note: If a verification still cannot be completed after verifying all the information is complete, you can at least verify if an insurance policy is active by going to the Athlete’s profile and inputting primary physician data in the medical tab.   See Below:

The Athlete must input their primary care physician name and primary care physician NPI number in the doctor section here. (Doing this will override the settings in the Phone Book for this specific athlete record.)

This way, you can see if this Athlete has active insurance with their primary care physician by bypassing running the verification on the team doctor’s NPI.

Managing Monthly Verifications

Automating your workflow with Monthly Verifications ensures that athlete coverage is checked and updated every 30 days without manual intervention.

1. Confirming Eligibility

Before adding an athlete to the monthly cycle, ensure their profile contains the following required data:

• Selected Payer: A provider must be selected from the dropdown menu.
• Member ID: The insurance unique identification number.
• Policy Holder Information: Full First and Last Name, and Date of Birth.

Troubleshooting Data Gaps:
If required information is missing, a Warning Icon (!) will appear to the right of the athlete’s name.

• Identify Errors: Hover your cursor over the icon to see a pop-up list of missing fields.

·         Update Profiles: Click VIEW/EDIT to open the athlete’s record directly. Once you update the fields and click SAVE, you will be returned to the Insurance Verification Manager.

2. Verification History & Credits

• Last Verification Date: Displays the most recent date the policy was checked.
• Verifications Left: Shows the remaining number of automated checks available for that specific athlete.
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3. Detailed Coverage Breakdown

For a deeper look, the module provides a Yes/No status for specific service types, including:

• Health Benefit Coverage & Medical Care
• Emergency & Urgent Care
• Hospital & Specialist Services

At CSMi, our goal is to simplify the complexities of sports medicine management. We hope this insurance verification tool allows you to spend less time on paperwork and more time focusing on athlete health and performance.

Keep in Touch:
We are constantly improving SportsWareOnLine. If you have feedback on this module or need help getting started, don’t hesitate to reach out!

Support: For assistance, contact SportsWareOnline Support. 781-297-2034 You can also email us at support@sportswareonline.com