Aug

20

Medisoft Medical Billing Software - Insurance Company Setup, Part 3

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 - EDI/Eligibility Tab- You will only set this up if you are enrolled with a Medisoft Approved Clearing House (Medavant, Relay Health, Claims Manager, Phoenix.  For more info, call 888-691-8058 or 941-743-6666).
This tab is where you enter this carrier’s information for electronic claims and online eligibility verification.

EDI Receiver: Click the down arrow to select the EDI receiver to which you send this carrier’s claims.

EDI Payor Number: Enter the carrier’s payor number.  You get this number after enrolling in electronic claims.

EDI Sub ID: Your electronic claims manual will tell you if you need to enter a number in this field.

EDI Extra 1/Medigap: If the carrier you are setting up is used within the practice as both a primary EDI insurer and a Medigap insurer, you must enter the Medigap number in this field. The number entered is the COBA Medigap claim-based identifier received from the national Coordination of Benefits Contractor (COBC).

EDI Extra 2: Your electronic claims manual will tell you if you need to enter a number in this field.

Biller Code: This field is for electronic claims, usually when sending to GPNT but may also be used when sending to other carriers.  Your electronic claims manual will tell you if you need to enter a number in this field.

NDC Record Code: Your electronic claims manual will tell you if you need to enter a number in this field.

Complimentary Crossover: Click this box if you are filing complimentary crossover claims.  Secondary insurance will not be sent in the claim file.  However, the program will mark the secondary as sent.  If you are sending Medigap claims, do not click this box.

EDI Max Transactions: If applicable, enter the maximum number of transactions accepted by the carrier.  This field is available for those carriers that limit the number of transactions per claim accepted electronically.  If you submit more than the maximum number of transactions per claim, the program automatically splits the claim. See EDI Transmission Limits.

Submitter ID: Enter the submitter ID for this insurance carrier.  Your electronic claims manual/checklist will tell you if you need to enter a number in this field.

Associated Payer: Click the magnifying glass to select the payer associated with this insurance company.  The Select Payer window opens.  You can either scroll through the list until you find the payer or click Set Filters to search through the list.  If you do not see a payer in the list, then the clearinghouse does not support that payer at this time.

Claims Payer ID: This field displays the payer ID for claims.  If n/a appears in the field, this payer is not supported for claims.

Eligibility Payer ID: This field displays the payer ID for eligibility.  If n/a appears in the field, this payer is not supported for eligibility.