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.

Aug

4

Medical Billing Software - Medisoft- Setting up new referring providers Part 1

Filed Under Medical Billing, Medisoft, Practice Managment | 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 - Address Tab;
Code: The referring provider code can contain up to five alphanumeric characters and identifies the referring provider in the program.

Inactive: For information on the Inactive check box, click here.

Last Name, First Name, Middle Initial: Enter the provider’s demographic information. A referring provider can be a doctor, nurse, technician, or physician’s aide who deals with patients. Enter the referring provider’s name in the name fields and his or her address and phone numbers in the correct fields.

Credentials: Credentials gives you seven spaces to enter characters indicating the referring provider’s credentials, such as MD, Ph.D., RN, DO, DC, etc., or whatever applies.

Street, City, State, Zip Code: Enter the provider’s demographic information.

NOTE: When entering an address, the focus of the program moves to the Zip Code field after the Street field. Enter the zip code. If that code has already been entered in the program database, the city and state information is automatically entered in their respective fields. If the zip code is not found in the database, the focus of the program returns to the City and State fields for your input. This information is then saved to the database and available the next time the zip code is entered. For more information on this feature, see Program Options - Data Entry Tab.

After entering a Zip Code and auto populating the City and State fields, if you then go back to the Zip Code field and change the value entered without first saving it, the system will not change the City and State value previously entered, producing an inaccurate record. Use care when changing an auto populated City and State field without first saving the initial entry.

E-Mail/Phone Numbers: Enter the referring provider’s E-Mail and other Phone Numbers in the spaces provided.

Medicare Participating: This check box should be clicked if the referring provider is committed to working with Medicare.

License Number: Enter the referring provider’s license number.

Specialty: If you are sending electronic claims, select the referring provider’s special field of practice. If you need to use a specialty code that is different than the usual code, select “Not Listed” and enter your specialty code in the data entry box that appears next to the Specialty field.

NOTE: This field is not used for sending paper claims unless you have modified your claim form to include this information.

Entity Type: The Entity Type field is to identify whether the entity is a Person or a Non-person. This is for sending electronic claims. Read more

Jun

23

Medisoft Medical Billing Software, Create a new set of data

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Medisoft Medical Billing - Create A New Set of Data

NOTE: Medisoft is very unique in that you are not charged for each practice you setup and use.  This makes Medisoft an ideal software for biling services as you are not charged “per practice”.

Use this window to create a new set of data in your Medisoft billing software. Go to the File menu and select New Practice. The Create a new set of data window opens.

Enter the practice or doctor’s name to identify this set of data: Enter a name to identify the practice. You can use up to 35 characters.

Enter the data path: Enter the practice’s data path. The entire data path is restricted to 100 characters.

Browse: Click this button to search for a data directory. This option is available to reinstate a practice that has been removed from the list or to locate a lost data directory.

Jun

19

Medisoft Medical Billing Software - At a Glance

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Medisoft at a Glance - a Brief Description and Links to Key Windows and Features

NOTE: this list does not include all the windows and features of Medisoft, but a few of the key features popular with many users.

Setting up Your Practice

The Provider window contains important information about the providers associated with your practice.  Each provider in the practice needs to have his or her own record set up in the database.  You will use the Provider Class window to enter classes or groups for providers in your practice including group NPI numbers. The Referring Provider window contains important information about the referring providers associated with your practice.

You will use the Insurance Carrier window to enter insurance carrier records, and the Addresses window is used to enter address information important to your practice.

The Diagnosis List window displays all diagnosis codes that have been entered into the database and controls to edit or enter new codes. You will use the Procedure/Payment/Adjustment Code window to enter and edit, etc. procedure codes.

If you process electronic claims, you will use the EDI Receivers window to set up/edit EDI receivers.

The Patient List window is the main space for entering/editing patient and case information. Medisoft 14 introduces another method for Medisoft Advanced and Network Professional users, the Patient Quick Entry window, for creating and editing patient and case records that provides custom data entry and display options.

You can also take advantage of Medisoft’s security features and set up different users with varying degrees of permissions to application functions.

Scheduling Appointments

Scheduling appointments is simple using Medisoft’s integrated appointment scheduling application, Office Hours .

Entering Transactions and Payments

You enter charges via the Transaction Entry window and you can also apply payments using this feature. Users of Medisoft Advanced or Network Professional can take advantage of the Deposit List window for entering payments.

Generating Claims and Statements

Claims processing centers on the Claim Management window from which you can create, edit, and print/send claims. New in Medisoft 14 is support for UB-04 claims .  And you can use the Statement Management window (available in Medisoft Advanced or Network Professional) to create billing statements for patients.

Running Reports

You can use the robust reporting capabilities of Medisoft to keep track of your office’s performance. Medisoft offers a rich list of reports to manage office functions and analyze your practice’s performance.

Running Utilities

Medisoft also provides easy automation of several functions via the Task Scheduler and EMR interfacing via the Communications Manager . New in Medisoft 14 for Advanced and Network Professional is the Dashboard , a utility that monitors and displays key functions of the practice.

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