Aug

15

Medisoft Medical Billing Software - Insurance Company Setup, Part 2

Filed Under Billing, Medical Billing, Medisoft, Training | Leave a Comment

Over the next several blogs, we are going to be providing you info on How To Setup a New Insurance Company, To Get Started, Open Medisoft Medical Billing Software Program, Click on the Blue Cross icon, or click on LISTS: INSURANCE COMPANY.

Insurance Carrier Entry - Address Tab
This tab is where you enter this insurance carrier’s demographic information.

Code and Inactive: Each carrier is assigned a unique code. You can assign the code or allow the program to assign it automatically. Click the Inactive check box to mark the insurance carrier inactive.

Name and Address: Enter the insurance carrier’s name and address. Following the name, type the street, city, state, or zip code that helps you identify the right carrier.

Phone, Extension, and Fax: Enter the insurance carrier’s phone and fax numbers.

Contact: Enter a contact person at the insurance carrier. This is for reference only and doesn’t print on a claim form.

Practice ID: Enter the ID assigned to the practice by the insurance carrier.

**Insurance Carrier Entry - Options Tab
This tab is where you enter this carrier’s plan identification and billing options.

Plan Name: At the top, enter the Plan Name administered by this carrier.

Type: Click the down arrow to select this carrier’s type.

Class: To improve search routines and reporting, insurance carriers can be grouped.  This field lets you assign the carrier to a dynamic list of carriers you create yourself.  You determine what the categories are, and you can add an unlimited number of categories to the program.  See Insurance Class Entry.

Plan ID: This field is provided to contain the Health Plan Identifier, which will be implemented by insurance carriers.  It is expected to consist of ten numbers that identify a contract between the provider and carrier to conduct or process transactions of health plans in compliance with HIPAA requirements.

Alternate Carrier ID: This field is an open field for use by external programs.

Delay Secondary Billing: If there is a secondary (or tertiary) insurance company, you can delay printing the secondary claim form until a response is recorded from the primary carrier.  To activate this operation, click in the Delay Secondary Billing box.  A check mark appears to indicate the operation has been activated.

To print the secondary claim form at the same time the primary is printed, leave the box empty (which is the default setting).

Code Sets: The Procedure Code Set is part of a built-in cross-reference for assigning more than one code for the same procedure

Different carriers can have different numbers for the same procedure.  For example, for a Medicare claim, an office visit is 99213, a carrier that has not changed to the new evaluation and management codes refers to the same office visit as 90060.

Medisoft gives you the ability to assign up to three codes to the same procedure.  By using this field, the claims for each carrier can contain the correct code.

Enter the Procedure Code Set you want this carrier to use from the procedure code file when creating claims.  Since a procedure can have three separate codes, you assign this carrier to read Code Set 1, Code Set 2, or Code Set 3.  See Procedure/Payment/Adjustment Entry.

Treat the Diagnosis Code Set in the same manner as outlined above for the Procedure Code Set.

Patient, Insured, or Physician Signature on File: These fields control what is printed in the signature Boxes 12, 13, and 31, respectively, on the CMS- or HCFA-1500 claim form.  These fields do not control whether anything is printed in these boxes, but what is printed.  Whether anything prints is controlled in the patient and provider files, specifically the patient Case window, Policy tab, Accept Assignment and Benefits Assigned field, and Provider edit window, Address tab, Signature on File field.

What prints is determined by the selection in this Signature on File field in the Insurance Carrier entry window.  The options are:

Option
Result

Signature on file
Prints “Signature on File” (if the Signature on File field has been activated in the patient and provider records).

Print name
Prints the party’s name.

Leave blank
Prints nothing.

Print PINs on Forms: Every patient is assigned a provider in Medisoft and this provider’s information appears in Box 33 of the claim form.

Current Medicare and Medicaid regulations require, if the attending provider is not the assigned provider (shown in Box 33), that the attending provider’s (the one providing the services) name and PIN be entered in Box 24K on the CMS- or HCFA-1500 claim form.

At this time, only Medicare and Medicaid have this rule.  When setting up these two carriers, select the provider name and PIN for this field; otherwise, leave it blank.

Default Billing Method: This field identifies the mode(s) of handling claims.  In the drop-down list, click Paper if claims are to be printed on paper; click Electronic if claims are to be transmitted electronically.

Medical Billing Software, Medisoft Training