Insurance Class

The Insurance Class dictionary contains the various payors associated to a practice. They are commonly the same list of payors found in the PMS. In the EHR dictionary, the key fields to the Insurance Class entries are Code, Name and Mnemonic. These can be entered manually or bulk-loaded by the implementation and interface team. If the SureScripts and/or RxHub (see E-prescribing) functionality is available and deployed, the prescription formularies will be available to providers in the Rx+ module.

Multi-Organization's sharing a single PMS instance

In an environment that shares a common PMS can simply build the Insurance Class dictionary into the EHR, copying the codes, names, and mnemonics.

Multi-Organization system interfaced with multiple PMS

In this circumstance, each distinct instance of the PMS's Insurance Class may either be added or a standardized Insurance Class dictionary is built and subsequent Organizations/PMS Insurance's are mapped to the standard set of Insurances.

When mapping insurance classes, two fields are critical - the FSC and the Company ID (HL7 segment IN1, fields 2 & 3). These will uniquely identify the insurance payor and plan in the PMS, allowing the practice to submit claims accurately. Mapping the insurances from the PMS to EMR is a complex process and resources familiar with the codes should be heavily involved in the process.