Aug

30

Medical Billing Software - Insurance Classes

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

Insurance classes are used to categorize insurance companies for reporting purposes.  Each  insurance company can be assigned only ONE “class”.  Then when running reports, you can specify an Insurance Class to run for reporting, instead of a range of insurance companies.

Click on LISTS: INSURANCE: INSURANCE CLASS

Insurance Class Entry
Use this window to create insurance classes, such as Blue Shield or Medicare.  Use these classes to group insurance carriers for easier reporting.  Insurance categories are like patient codes or patient types.  They are user-definable and can be used to assign insurance companies to a certain group.  And you can add an unlimited number of categories to the program.  For example, you can create a Medicare group, or a Blue Cross/Blue Shield group.  Insurance classes are assigned in the Insurance Carrier Entry window, Options tab.

Creating an Insurance Class
Go to the Lists menu and select Insurance and then Classes.  In the Insurance Class List window, click New.  The Insurance Class window opens.

Class ID: Create a class ID for this group.

Class Name: Enter a name for the class (such as Medicare, or Blues).

Description: The Description field is a 100-character field for entering an extensive description.  It scrolls as you enter the data.

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Aug

25

Medisoft Medical Billing Software - Insurance Company Setup, Part 4

Filed Under Billing, Medical Billing, Medisoft, Setup, 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 - Codes
This tab is where you enter this carrier’s default payment and adjustment codes.  When you apply payments/adjustments from this carrier, the program automatically uses these codes.

Payment: Click the down arrow to select a default payment code.

Adjustment: Click the down arrow to select a default adjustment code.

Withhold: Click the down arrow to select a default code for entering withhold amounts.

Deductible: Click the down arrow to select a default code for entering deductibles.

Take Back: Click the down arrow to select a default code for entering take backs.

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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.

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

Aug

10

Medisoft Medical Billing Software - Insurance Company Setup, Part 1

Filed Under 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.

Aug

6

Medical Billing Software - Medisoft- Setting up new referring providers Part 3

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

Over the next several blogs, we are going to be providing you info on How To create a new Referring Provider, To Get Started, Open Medisoft Medical Billing Software Program, Click on the referring provider icon, or click on LISTS: REFERRING PROVIDERS.
Referring Provider Entry - PINs Tab (NOTE: DO NOT ENTER ANYTHING HERE IF YOU ONLY WANT YOUR NPI NUMBER TO TRANSMIT)
Depending on the type of claims you file, you could have separate PINs from each insurance for this referring provider.  This tab provides a PIN matrix where you can store these additional PINs.

PIN
Depending on the type of claims you file, you could have separate PINs from each insurance for this referring physician.  Enter the appropriate PIN for the insurance company.

Qualifier
If you send electronic claims, you may also be required to enter qualifiers for the PINs.  These qualifier codes indicate the type of PIN being sent.  Refer to the implementation guide for your insurance carrier if you are not sure which qualifier to use.  This is not provided by Medisoft but by your carrier.  For a list of valid qualifiers, click here.

0B = State License

1A = Blue Cross Provider Number

1B = Blue Shield Provider Number

1C = Medicare Provider Number

1D = Medicaid Provider Number

1G = Provider UPIN Number

1H = Champus Identification Number

1J = Facility ID Number

B3 = Preferred Provider Organization Number

BQ = Health Maintenance Organization Code Number

EI = Employer’s Identification Number

FH = Clinic Number

G2 = Provider Commercial Number

G5 = Provider Site Number

LU = Location Number

N5 = Provider Plan Network Identification Number

SY = Social Security Number

U3 = Unique Supplier Identification Number

X5 = State Industrial Accident Provider Number

NOTE:  If you converted data from Medisoft 10 or previous, the qualifiers may have been converted as well.  Verify that the qualifiers are correct for each PIN and/or Group ID.

Aug

5

Medical Billing Software - Medisoft- Setting up new referring providers Part 2

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

Over the next several blogs, we are going to be providing you info on How To create a new Referring Provider, To Get Started, Open Medisoft Medical Billing Software Program, Click on the referring provider icon, or click on LISTS: REFERRING PROVIDERS.

Referring Provider Entry - Default PINs Tab
SSN/Federal Tax ID: Enter the referring provider’s Social Security or Federal Tax ID Number.  This number prints in Box 25 of the insurance claim form.  Choose the radio button to indicate whether the number entered is the Social Security Number or the Federal Tax ID.  If you select Federal Tax ID, an X prints in the EIN box of Box 25 on the insurance claim form.  If you select Social Security Number, an X prints in the SSN box of Box 25 on the insurance claim form.

Note: if you want only the NPI number to transmit, please do not type anything in the following fields except the “National Identifier” field.
PIN Fields: In the PIN (Personal Identification Numbers) fields, enter all applicable PINs assigned by each of the major insurance types, e.g., Medicare, Medicaid, Tricare, Blue Cross/Blue Shield, Commercial, PPO, and HMO carriers.

UPIN: If the referring provider is part of a group practice which has been assigned a group number by Medicare, that number is entered in the UPIN field.  The UPIN is necessary for designating a referring provider on the insurance claim form.

EDI ID: This field may be required when sending electronic claims.

National Identifier(NPI): Enter the provider’s National Provider ID.  This 10-digit number is a standardized identifier that provides each provider with a unique identifier to be used in transactions with all health plans.

CPO Number: This field is for electronic claims.  Enter the provider’s care plan oversight number.

Extra 1/Extra 2: These fields may be required when sending electronic claims.

Jun

17

Introducing Medisoft Medical Billing Software Discussion Forum

Filed Under Billing, Billing Service, Medical Billing | Leave a Comment

Participate in our new medical billing software discussion forum. Post questions on medisoft billing software or post questions about medical billing or coding issues. Medisoft Medical Billing Software Discussion Forum

Apr

10

Medical Billing Software Blog Introduction

Filed Under Billing, Billing Service, Medical Billing, Medisoft, Practice Managment | Leave a Comment

Medical Billing Software is what this blog is all about.  Got questions about medisoft medical billing software, or about what it can do, or what reports it has, or who’s the best place to purchase from, or anything else medical billing relalted- just ask!