Patient Profile

The patient profile holds a patient's demographic details, insurance policies, records export, communications log, and payment methods. Insurance claims, superbills, eligibility checks, prior authorizations, and lab orders all pull the patient's name, gender, MRN, date of birth, address, and insurance policies from here, so keep it up to date.

Most profile details are filled in automatically when the patient is registered. Follow the instructions here to register patients.

For more details, check out our API documentation on patients and insurance policies.

Prerequisites

Part 1: Set up medical centers and peer groups (EMR)

Patients are assigned to medical centers and peer groups from their profile, so create these first.

Follow the instructions here to set up your medical centers and here to set up your peer groups.

Part 2: Set up custom fields (EMR)

Any custom fields you define for patients appear at the bottom of the profile section.

Follow the instructions here to set up custom fields.

Part 3: Set patient portal access controls (EMR)

Patients can view and edit their own insurance policies from the patient portal if you allow it. Under Settings > Access Controls > Insurance Details, turn on “Can view insurance details” and “Can edit insurance details”. Patients cannot edit their own demographic details from the portal; those are set during registration and by organization members in the EMR.

Follow the instructions here to set access controls.

Steps

Step 1: Open the patient profile (EMR)

To open a patient's profile:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click “Patients” in the left sidebar and click on the patient to open their chart
• In the patient panel on the left of the chart, click the “Details” button in the top right corner
• This opens the “Patient Profile” page. Only organization members with permission to edit patients see the “Details” button.

Step 2: Edit demographic details (EMR)

The fields below are required when a patient is registered and are the ones insurance claims, superbills, and prescriptions pull from. The profile page itself does not block saving if one is blank, so check that each is filled in.

To edit a patient's demographic details:

• Open the patient profile
• In the “Profile” section, click “Edit”
• Make sure the following fields are set:
  • First Name, Last Name, and Preferred Name: The patient's legal name and the name they prefer to be called. The legal name is used on claims.
  • Medical Record Number: The patient's MRN. This is generated automatically and cannot be edited.
  • Status: Active, Prospect, Pending, Discharged, Archived, or Duplicate. Archived is only available to members with permission to archive patients. Selecting Duplicate opens the “Merge Patients” modal so you can merge this patient into another record.
  • Email: The patient's email address, used for the patient portal invite and notifications. Email is the one field that is not autosaved. Click the “Update” button next to it to save the change.
  • Phone: The patient's mobile phone number in the format (XXX) XXX-XXXX.
  • Date of Birth
  • Gender: Select from the presets or type in a value.
  • Address: Nickname (e.g. Home), street, apt/suite, city, state, and zip code. The first address is used on insurance claims and superbills.
• All information set is autosaved so click “Finish”

All other fields on the profile (pronouns, social security number, copay, birth sex, race, ethnicity, preferred language, medical centers, timezone, peer groups, care team members, notes, emergency contacts, guarantors, and custom fields) are optional.

Step 3: Add insurance policies (EMR or Patient Portal)

To add an insurance policy:

• Open the patient profile
• Scroll to the “Insurance Policies” section and click “Add Policy” (or “Add Insurance Policy” if the patient has none yet)
• Click on the new policy card to expand it and fill out the requisite information:
  • Plan Details
    • Insurance Company: Search for the payer or type in a new one.
    • Plan Type: PPO, EPO, HMO, HMO — Medicare Risk, Medicare Part A, Medicare Part B, Medicaid, Veterans Affairs Plan, or Other.
    • Plan Name: The name of the plan (e.g. Choice Plus).
    • Policy Status: Primary, Secondary, Tertiary, or Inactive. A patient can have only one primary and one secondary policy but multiple tertiary policies. Claims and eligibility checks are run against the policy you choose, so mark the patient's main coverage as Primary.
    • Start Date and End Date: The policy's effective and termination dates.
  • Policyholder Details
    • Patient Relationship to Policyholder: Self, Child, Mother, Father, Spouse, or Other. If the patient is not the policyholder, also enter the policyholder's first name, last name, gender, date of birth, and address.
  • Insurance Card Details
    • Member ID and Group Number: From the patient's insurance card.
    • Rx BIN and Rx PCN: Pharmacy benefit identifiers from the insurance card, used for prescriptions.
  • Insurance Card Photo: Drop or click to upload images of the front and back of the insurance card. Hover over an uploaded image and click the X to remove it.
• All information set is autosaved so click “Finish”

Once a policy is added, you can run an eligibility check against it. Follow the instructions here to run eligibility checks.

The profile page is not the only place a policy can be added. Any of the following attaches the same insurance policy to the patient, so use whichever fits your workflow:

• Forms: Add an “Insurance” question to an intake form so patients enter their own policy and card photos when they register. Follow the instructions here to build the form.
• Patient panel: In the “Insurance” block of the patient panel on the chart, click the plus icon. This opens the “Add Insurance Policy” wizard, which walks through card photos, plan details, policyholder, and card details. In the wizard, insurance company, plan type, plan name, policy status, relationship to policyholder, policyholder name, and member ID are required.
• Patient portal: Patients can add and edit their own policies if the insurance access controls are turned on (see Prerequisites).

Step 4: Edit or delete insurance policies (EMR or Patient Portal)

To edit or delete an insurance policy:

• Open the patient profile and scroll to the “Insurance Policies” section
• Click on the policy card that you want to edit/delete
• If you want to edit, modify details of the policy as desired and click “Finish”
• If you want to delete, click the trash icon in the lower righthand corner of the card and click “Delete” in the “Confirm Deletion” modal. This cannot be undone.

Step 5: Export patient records (EMR)

The “Patient Records” section lets you download everything on file for the patient in one export.

• Open the patient profile and scroll to the “Patient Records” section
• Click “Export Records”. The number in parentheses is how many files will be included.

Follow the instructions here for organization-wide exports.

Step 6: Review the communications log (EMR)

The “Communications Log” section shows when the patient last signed in to the patient portal and the emails sent to them.

• Open the patient profile and scroll to the “Communications Log” section
• If the patient has not claimed their portal account, click “Resend Invite Email” to send the invite again

Step 7: Add payment methods (EMR)

If you have a Stripe integration, you can store a card on file for the patient so invoices can be charged to it.

• Open the patient profile and scroll to the “Payment Methods” section
• Click “+ Add Payment Method” and fill out the cardholder and card details

Follow the instructions here to charge a payment method on an invoice.