A Practice needs to configure different billing parameters such as claim number generation, rules for grouping claims and claim batches, setting up of clearinghouse information, etc. for efficient billing and accountability. Billing Options under the Advanced Setup menu helps such configurations.
Find Billing Options under the Advanced Setup menu and click on it. The Billing Options screen (Image 1) opens up.
Field descriptions below explain Billing options in detail
1. Claim #: This specifies the way in which claim numbers are prepared when a claim is generated for submission.
The first 2/3 digit of the claim number is configured by selecting one of the below options from the first drop-down box
- Legal Entity (Three-Digit LE) Code
- Two-Digit Provider Code
- Case number
Choose Sequence Number from the second drop-down and type in the starting sequence number in the adjacent text field.
2. Claim Batch #: This specifies the method of claim batch number generation.
3. Batch Grouping Rule: It shows the rules for grouping batches. These rules cannot be edited as it is information purpose only. However, clearinghouse (EMC Receiver) information can be configured here.
a) Configure Clearinghouse Information: Clearinghouse details can be entered/edited by clicking on the button adjacent to EMC Receiver. A new window (Image 2) opens up when the button invoked.
Click on the Edit button against the clearinghouse to edit the information. To add a new clearing House, click on the Add button on top. The below screen appears when the Edit/Add button invokes.
Click on the Save button after entering sufficient details or editing existing information.
4. Claim Batch Name: This field assists in configuring claim batch names. This field has been added for future enhancements. Presently, it is not used.
5. Payment #: This specifies how the payment number is generated. Select the Legal Entity(LE) ID/Insure ID from the first drop-down. The payment # will be of the form LE ID/Insure ID – Sequence Number.
6. Patient Statement #: The fields against Patient Statement # defines how statement numbers are formed.
[Custom ID/3-digit LE ID/2-digit Provider Code] PS-sequence number.
The start field can be used to provide the starting number for the sequence.
7. Default Claim Response Limit: This field defines the threshold of the default claim response limit. For those insurances whose Response Limit Threshold field in the Insurance master page is empty, the system will take this field as the claim response limit.
8. Default Place of Service: This is used for setting the default value for Place of Service in the Enter/Edit Charges screen.
9. Auto generate PSTS #: PSTS is a tracking number system for creating entries such as payment entry, charge entry, and so on. The option here will enable us to set auto-generation of PSTS number. If set to Yes, a PSTS number is automatically generated, and if it is No, auto-generation will not occur.
10. Auto Post Patient Payments: if this option is enabled, it will assist in auto-posting patient payment in On-account. If an On-account balance exists and if the patient has due, the system will automatically post patient payments when the line status is set to BILL_TO_PT.
11. Show Payable Address for Patient Statements: If the address field in Patient statements is to be set to Payable to address of the practice rather than the physical address of the Practice (Both these addresses are given in the practices’ master page), select the Yes option. If set to No, the physical address of the Practice will be displayed in Patient statements.
12. Auto Save ERA: Generally, ERAs are downloaded by clicking the in the ERA posting screen under Payments in the main menu. If Auto Save ERA is set to Yes, ERAs received from the clearinghouses will be automatically downloaded to the system.
13. Auto Create COB Payer From ERA: This is used to enable or disable auto creation of COB Payer from ERAs. Select ‘Yes’ to enable the auto creation feature.
14. Hide Taxonomy from Paper Claims: If the taxonomy ID is to be hidden/removed from paper claims, set this option to Yes.
15. Payment receipt Address: This is a drop-down list that enables you to choose between LE address and practice address. The payment receipt will have the selected address.
16. Show inactive legal entities in the report search parameter: If set to ‘Yes’, the LE search drop-down in the following reports will show inactive Legal Entities as well: I6. Posting Details Report, I8. Summary Encounter Line Activities Report, J1. System Financial Summary Report, J9. Daily/Month End Close Report, J6. Charges/Payments Reconciliation Report, J7. Monthly Activity Analysis Report.
17. Untimely Filing Limit: Set Default Threshold days
18. Response Limit Threshold: Set Default Threshold days
19. Exclude Co-Pay from CHMO Write-Off: Set this to ‘Yes’ to exclude the copay balance from the automatic write-off feature for insurances flagged as capitated. (The system determines the copay amount to be left on the line from either the primary payment postings or the co-pay amount saved in the patient’s primary insurance plan.)
20. Setup SuperBill: This button at the bottom of the Billing Options page is used for setting up a superbill for the practice. Click here to know more about setting up superbills.