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Documentation Index

Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt

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The Insurance & Eligibility panel surfaces within the patient record at /pm/patients/:patientId (Insurance tab) and gives billing staff a per-patient view of active policies and eligibility check history.

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Overview

The insurance panel lists all insurance policies attached to a patient, ordered by coordination of benefits (COB) priority (primary, secondary, tertiary). Each policy card displays the payer name, policy status badge, effective and termination dates, and the result of the most recent eligibility check. A coverage-gap alert fires when no active policies are on file or when the latest check for an active policy returned ineligible or is overdue. Users with pm.insurance.manage permission can add, edit, terminate, or soft-delete policies and adjust COB priority order. When the module setting cob_order_change_triggers_reverification is enabled, reordering policies automatically prompts an eligibility re-check.

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Who it’s for

Requires pm.insurance.view (PM_PERMISSIONS.INSURANCE_VIEW). Manage actions (add, edit, terminate, delete, run eligibility) additionally require pm.insurance.manage (PM_PERMISSIONS.INSURANCE_MANAGE).

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Before you start

  • Navigate to a patient record at /pm/patients/:patientId and select the Insurance tab.
  • The patient must exist in the system and your role must include pm.insurance.view.

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Steps

1

Open the patient's Insurance tab

From the patient detail page, select the Insurance tab to load the policy list and eligibility check history.
2

Review policy cards

Each card shows payer name, COB priority (Primary / Secondary / Tertiary), policy status badge, effective dates, and the latest eligibility check result. A destructive alert banner appears if no active policies are found or an active policy is ineligible or overdue.
3

Add or edit a policy

Users with pm.insurance.manage may click Add Policy (top-right) or the edit action on an existing card to open the policy form dialog.
4

Run an eligibility check

Click the run-check action on a policy card to open the eligibility dialog. The check queries pm_eligibility_checks and updates the latest-check badge on the card.
5

Adjust COB order

Use the priority selector on each card to change the COB order. If the module setting cob_order_change_triggers_reverification is on, a re-verification prompt opens automatically.
6

Terminate or remove a policy

Terminate marks the policy end date; soft-delete sets deleted_at and hides the policy from the active list. Both require pm.insurance.manage.

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Key concepts

When no active policies are found, a destructive banner reads “No active insurance policies on file. Claims may be rejected.” An empty-state card prompts adding the first policy.
Fires when at least one active policy has a latest check with eligible === false or when next_check_due is in the past.
COB Priority — Coordination of Benefits order. Policies are ranked 1 (Primary), 2 (Secondary), 3 (Tertiary) and billed in that sequence. Eligibility check — A query against pm_eligibility_checks that records whether the payer confirmed active coverage on the check date. Benefit Detail Panel — An expandable panel on a policy card (component BenefitDetailPanel) that shows plan benefit details returned from the eligibility response.

Practice Management

Overview of the Practice Management core.

Governance & parity

Documentation coverage and governance.
This page documents shipped product behavior. It is not medical, legal, or billing advice. Verify against your organization’s policies and applicable regulations before using it for clinical, compliance, or billing decisions. Protected health information (PHI) shown in the product is governed by your tenant’s access controls and is never exposed in this documentation.
  • src/routes/pm.tsx
  • src/cores/pm/components/PatientInsuranceList.tsx
  • src/cores/pm/hooks/useInsurancePolicyList.ts
  • src/cores/pm/hooks/useEligibilityCheckList.ts
  • src/platform/permissions/constants.ts
  • src/platform/navigation/route-labels.ts