Add Payers

IF A CLINIC IS A CASH PRACTICE AND DOES NOT BILL THIRD PARTY INSURANCE COMPANIES, PROVIDE PATIENTS WITH CLAIM FORMS TO SUBMIT OR CREATE SUPER RECEIPTS FOR REIMBURSEMENT, THIS AREA WILL NOT BE USED

The system comes preloaded with some sample insurance payers, a clinic can edit the payers listed with info that matches their area or inactivate them if they are not useful.

To prepare to enter in all the insurance companies from a previous software, we recommend a clinic creates a screen capture and print out of each insurance company in their old software.  Once all the information is printed out, the process of entering them into the software can begin. This prevents a lot of back and forth to save time.

When editing any information within Payers, Please remember to SAVE each time

To Add an Insurance Payer

Step 1: Under Admin

Step 2: Select Payers

 

Step 3: Click Add button in the bottom left corner

 

Step 4: Click on the “General” tab to add the Insurance company’s address and phone number.

If a Payer has provided you with a specific Electronic ID to process claims electronically you will also enter that in the General Tab.

 

Step 5: Click on “Printing Options”

This is where you will determine the format in which each insurance company requests data on the HCFA form regardless of whether you are printing on paper or submitting electronically.

Each Payer may require the HCFA 1500 to be generated with different data. The Printing Options tab displays a template that was downloaded to your software that should be suitable for most insurance companies but it allows you to change data based on the specific Insurance payer’s needs.

Any location under the Printing Options tab that can be customized with required information will contain a drop-down to select or a box to click on. A clinic will need to consult with their Clearing House, Billing Company and/or the Insurance Companies to ensure that the template is set properly.

The first box prompts you to select Primary, Secondary or Tertiary.  This indicates to your software what payer level the settings are being applied for.

The box next to it reads “1500 Output Option”.  This is where you would set the default on whether you want the claim processed electronically or on paper.

Be sure to set defaults for primary, secondary and tertiary.

For example, a Payer may have you bill electronically when it is billed as the Primary, but then require you to bill on paper if it is being ran as a Secondary.

The next option is to indicate the “HCFA 1500 Version”. This tells the system what claim form will be used.

As of April 1st, 2014, most payers require submission of claims utilizing the CMS 1500 02-12 form.  If you run into a scenario where a certain payer is asking for previous version of the CMS 1500 form, 08-05, you have the option to select that as well.

 Box 1 is going to be different for each insurance company based on the type of Payer they are (i.e. Group, Medicare, Medicaid, etc).

Another area to highlight is Box 21, located lower on the form

You must indicate which ICD codes you will be using for each payer.  Box 21 has a drop down to indicate if you are using ICD 9 codes or have transitioned to the ICD 10 codes.

As of October 1st, 2015, generating claims that contain dates of service after Oct 1st, 2015, must be submitted with ICD 10s.

9 times out of 10, if a clinic cannot pass scrubbing for Box 21, it is because the payer is set to grab ICD 9s instead of 10s

Lastly click on the “Scrubbing” tab.

This screen tells the system which fields are required to be filled out for a claim to be generated.

If a claim does not pass the Scrubbing test, the system will generate a Scrubbing Report.

It will tell you the patient's name, case, date of service, why the claim could not be generated and where to go to fix the problem.

The location you will need to go to is within the (   ) to the right of the issue.

This feature is available so that an issue can be corrected before it is submitted.

This will save time and money when used properly, so you are not waiting for it to get kicked back from your clearinghouse before you are able to correct the issue.

Any Highlighted box in yellow is set as a requirement. Meaning that any box highlighted yellow indicates that info will be printed in that box. Any box that is highlighted white means that info will not be printed in that box:

This template is set up in such a way that it should work for most insurance companies. However, when entering Medicare, you must ensure that a second Diagnosis code (Box 21) is highlighted as well as the first modifier box.

*Also, when billing Medicare, we have been notified by Office Ally that Medicare sees claims in what they call “Loops and Segments”. This means that the current injury onset date that is placed into Box 14, is also required in Box 15 with a modifier 454.

- Support Information -

 If you have any questions or need assistance with this process please contact Support by:

Live chat: Click the 'Support Portal' button in your main toolbar (on left-hand side), click the green 'Support' box in bottom right of screen.

***This has the fastest response time***

Phone/Text: 909-378-9514

Email: [e-mail]

Business hours: Monday-Friday, 8:00am-6:00pm CST