The Insurance Setup screen has multiple functionalities. Depending on how the provider/organization is credentialed, some claims may need to be billed with an individual NPI or SSN while another is billed with the group NPI and TIN. You can use this screen to set up the provider to bill claims for payers that use the information they were credentialed with.
You can use this feature to set up each provider, per payer with the requirements (TIN/SSN/Group vs Individual NPI/state license number/etc) to help ensure your claims are accepted for processing for the payer as quickly and efficiently as possible.
- Select Billing > Insurance Setup.
This screen shows all the insurances that you are billing along with the billing information (NPI, Tax ID, Organization Name) that you have updated in the Account > Provider Settings > Billing.
If you do not see a payer that you need listed, select Add Payer and enter the information. Once you refresh your screen, the payer will be listed.
- To edit or update any information, select the pencil icon corresponding to the payer.
The Add/Edit Payer page has many options.
- Billing NPI - If you have two NPIs (Group and Individual), you can switch between the two depending on how you are credentialed with the payer. This is reflected in HCFA box 33a.
- Eligibility NPI - If you get an eligibility error message regarding enrollment, you can switch the NPI depending on how you are credentialed with the payer for eligibility. This is the NPI that the system uses to check a patient's eligibility and benefits.
- Provider name - Select the provider/practice name and this information is reflected in Box 33. Example: Select Provider Name if the billing NPI is individual.
- Tax ID number / TIN - Depending on how the provider is credentialed with the payer, you can switch between the billing with either the TIN or SSN.
- Group Provider # - If the insurance is requesting the group provider number in box 33b (shaded column), enter the group provider number in this field and choose the Example: Indicate whether it is Taxonomy or State License.
- Individual Provider # - If the insurance is requesting the individual provider number in box 24j (shaded column), please enter the individual provider number in this field and choose the Individual Example: Indicate whether it is Taxonomy or State License.
- Balance billing - If you are out of network with the payer and would like to bill the patient for any adjustment (sometimes listed as R & C amount), select YES. This transfers the adjustment amount toward the patient column.
- Filing limit days - If you know the timely filing limit for the payers, update in this field. You can retrieve a claim report in the Billing > Live Claims Feed by selecting the TFL Warning checkbox. This ensures that you don't miss out on reimbursement because the claim was not submitted in time.
- Accept assignment - If you clear this option, the insurance will send the payments directly to the patient and not to the doctor. To send claims with the accept assignment designation, leave the box selected. Some payers do not send payment directly to the provider, regardless of what is notated on the HCFA, if the provider is out of network.
- Send facility provider number - This number populates from the Account > Offices > Edit > Billing > Facility Provider Number field. It is reflected in HCFA box 32b (shaded field).
- Referring doctor/Ordering doctor - If you want a specific Referring/Ordering provider to reflect all patients who have this particular payer, enter the doctor's name that populates in this field. First, add the doctor's information to the Message Center as a contact.
- Print license numbers in HCFA - This number populates from Account > Provider Settings > eRx Info >
