1. To Add an Insurance Company, click on Setup module from the menu and choose Insurance/Plan.
2. In the Search Insurance Company page that appears, click the add button. The Insurance Company Information page will appear as shown below.
3. Enter the following information on this page:
|Company Name and Address|
|a) Enter the Name of the Insurance Company.
b) Ensure that the correct Payer Id is given for the Insurance. This Payer ID is required to send EDI claims.
c) Select the correct Payer Type from the list for e.g. Commercial Insurance Co etc. This is required for correct claim adjudication
d) Enter the End Date Effective to mark the insurance effective end date
d) Enter the Address, City, State, Zip Code and Country details.
e) In the Contact Info area, enter the Phone 1,Fax ,E-mail and the URL of the company website.
a) The Primary Billing Method should be set to EDI if the claims are being sent as EDI otherwise choose PAPER. The same needs to follow in Secondary Billing Method.
b) EMC Receiver field should be set to your Clearing house (for e.g. if your Clearing house is Emdeon, the EMC Receiver field should be set to Emdeon).
c) From the Procedure Code Set box choose CPT or HCPCS as the appropriate Procedure Code Set to be used.
d) The current Diagnosis Code Set being used is ICD9 and is set as the default option.
e) Exclude Prior PR.Payment needs to check only if we need to exclude the prior primary payments.
f) The Capitated Plan option should be selected only if this Insurance is being added for a Capitated Plan
g) The Eligibility Payer ID is required to enable Eligibility Check for this Insurance Company.
h) The Sub Payer id is required if additional identification number is necessary other than primary payer id.
i) The Claim Response Limit allows you to set the number of days to wait for response before listing the claim under the “No Response” Category and moving to the Collection Manager
4. After entering all the necessary information, click the Save button. The Insurance Company information will be added and updated.