Insurance Companies. Updated:

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1 Insurance Companies The Insurance Companies window will allow your practice to enter information for your insurance companies. The information entered on the Insurance Companies window will be reflected in patient s file once the Insurance Company is attached to a patient. To enter an Insurance Company: 1. Go to System Tasks Update Lists Insurance Companies. Note: ( + ) denotes fields that can be customized per patient. 2. Enter the following demographics: Insurance ID This is a six-digit code that you will create to indicate a specific insurance company throughout the system. In the search field enter % (Control 5) and tab to pull a list of current insurance codes from the system. Name This will print on the claim form. Address, City/State/Zip Enter the Address, City, State, and Zip Code Phone Enter the phone number. Fax This field will need to be completed in order to fax documentation to an insurance company. This field will need to be completed in order to documentation to an insurance company. Website Enter the Insurance Companies website if applicable. Notes Enter any general information pertaining to the company Updated:

2 Inactive Select the Inactive checkbox to remove the Insurance Company from your current active list. (Note: An insurance company cannot be deleted, only inactivated.) + Pin # Enter the PIN number for the Insurance Company (optional). + Group # Enter the Group number for members of an Insurance group (optional) Payment Group If your office receives bulk insurance payments, a Payment Group can be set up for the insurance companies. If the office has several Blue Cross Blue Shield insurance offices that are all paying from a single location, the same Payment Group name will be assigned to all. + Percent Paid This is the benefit coverage that the company is offering. Note: If entering a new Insurance Company, the system will default the Percent Paid to 100%. If migrating from 3.7, the Percent Paid will need to be set to 100%. + Max Units Per Day Enter the maximum units the insurance company will allow per day. Insurance Claim Form From the drop-down box, select the desired default claim form that will be submitted to the insurance company. In order to view any additional insurance forms under the drop-down, users will first have to choose the forms that will be used in the office. To choose the forms, go to Billing/Insurance Billing/Standard Options and select the forms that will be used. Select the Set as default standard options to save the settings. The claim forms will then appear in the drop-down list. Electronic Submit Choose this option when sending claims electronically in ANSI837 format. This can be done directly through PTOS or can be done through an outside clearinghouse. Updated:

3 Laser CMS-1500 (02-12) Choose this option when printing claims or sending a print image file on a HCFA form. Laser CMS-1500 (08/05) Choose this option when printing claims or sending a print image file on a HCFA form. Illinois Medicaid Choose this option when sending claims on an Illinois Medicaid form. New York Worker s Comp 1-11 Choose this option when sending claims on a NY Worker s Comp form. New York Workers Comp 8-09 Choose this option when sending claims on a NY Worker s Comp form. Ohio C19 Choose this option when sending claims on an Ohio C19 form. UB04 Choose this option when sending claims on a UB04 form. Practice Identification From the drop-down choose Practice Identification information associated with this Insurance Company. The Identification numbers will be set up under the Facility setup. The number will populate in box 32B on the HCFA form, 57A on the UB04. Box 9D/11C line 1 and 2 It is recommended that the information in the Insurance Name box be entered in this field. The information in this field will print the insurance company s name on any primary or secondary claim forms. Box 15 (02/12) From the drop-down how to complete box 15 on the HCFA 02/12 form. Choosing 454 Initial Treatment Date will enter the Treatment Date from the Patient Editor Case Tab. Choosing 304 Latest Visit Date will enter the date of the latest visit in the Patient Transaction Screen. Choosing Do not fill Box 15 will leave box 15 empty. Choosing Use Case Settings will enter the information set up on the Patient Editor HCFA/UB04 tab. Use Box 19 data from HCFA/UB04 tab Checking this box will pull data into box 19 from the information entered in box 19 on the HCFA/UB04 tabs. Box 19 (02/12) If using this option to enter specific numbers: Uncheck the box for Use Box 19 data from HCFA/UB04 tab. Choose the Set Options button. Updated:

4 Enter 1-6 in the Provider ID s priority box to determine the order in which the ID s will pull into Box 19. Within the Employee Setup in the Therapist Info, enter a specific identification number and choose the ID type within the drop-down. Include Period in ICD code in Box 21 Check this box to enter a period in the ICD Code on the claim form. Print Signature on File in Box 31 Check this box to print Signature on File in box 31 on the HCFA Form. Four Digit Date Check this box to print the patient s four digit birth year on the HCFA form. Fee Schedule Fee schedules are contracted fees that your office has agreed to charge for assigned companies. They are used when you want to charge fees that differ from your standard fees. Fee Schedules can be attached to insurance companies or to a patient through the patient editor. To set up a fee schedule, go to System Tasks/Update Lists/Fee Schedules. Updated:

5 Submit ICD10 Codes as of From the drop-down, choose the date to begin sending ICD10 codes to this Insurance Company. Note: The system will automatically default the date of 10/01/2015. Payer Info Information in this area will need to be completed when sending claims electronically. eservices representatives will complete this area with your office. eclaims Payer ID Before submitting electronic claims, each insurance company in your system must be assigned a Payer ID. Enter the Payer ID in this area. Payer IDs are specific to insurance companies. If using PTOS for Electronic claims, PTOS eservices will provide these numbers. If using an outside clearinghouse, it will be the user s responsibility to acquire these numbers from the insurance company. Payment Source From the drop-down, choose a payment source. Does Not Auto Assign Payer ID When selected, this option allows for payer IDs to be assigned manually. Enroll Provider before Send eclaims This option alerts you that this payer requires the provider to be enrolled in eclaims. eclaims Enrollment Completed This option indicates that the eclaims enrollment obligation has been met. Updated: