Insurance Companies

Insurance Companies

The Insurance Companies can be accessed by clicking on Codes Setup on the left, then click on Insurance Companies.

Any paper insurance companies that are added will be added to the paper payer list for you.  Any electronic insurance payers you add will be added to "MY Electronic Payer List" that is used in setting up the clients and for reporting.

You can set up insurance companies as either PAPER companies or ELECTRONIC companies. If you use a Paper Insurance Company to bill, you will need to print and mail those claims.

Setting up a Paper Insurance Payer:

To set up “paper” insurance companies (to create insurance CMS 1500 forms that you will mail yourself), click on “Add Insurance Company” next to PAPER Insurance Companies.

  • Fill in the applicable insurance payer and address.
  • What form to use? – To print the data AND the form, choose the Option “Insurance CMS-1500 (02-12)”.  To print the data on a pre-printed form, choose the option  “Insurance CMS-1500 (02-12) using pre-printed form”, and then you will need to do printer alignment adjustments in the Practice Setup.
  • Accept Assignment – defaults to “Yes”.  If you are billing as an out of network provider, you may change this to “No”.  
  • Special Overrides to Practice Setup – Any information entered in this section will “Override” any information entered in the Practice Setup.
  • Session Reminder Flags – This section is just a reminder field for you.  Any information entered will be available in the client session when you hover over “Insurance Note” in the upper right corner.  You MUST manually enter the information in the Client Session if you wish to have it on the claim, and after you enter it and save the session, the system will remember it when you enter the next Client Session.
  • Click “Save” when setup is completed.

Special Overrides to Practice Setup:

These are the overrides that can be done in the Insurance Company Setup:
  • Print Practice Name – This defaults to “No”, which prints the provider name as the billing provider name in Box 33.  If you need to use the Company name as the billing provider name, this drop-down box must be “Yes”.  
  • Suppress Taxonomy – defaults to “Yes”.  This does not change for paper claims.
  • Print NPI block 32 – defaults to “No”.
  • Use Office NPI – If an Office NPI is entered in the Office Locations Setup and this drop-down box is “Yes”, the Office NPI (from Office Locations) will print in block 32a.

Setting up an Electronic Insurance Payer:

EDI and ERA Enrollment:  Some payers require EDI enrollment through the clearinghouse to allow electronic billing.  Please view this article for more specifics on how to enroll:  EDI and ERA Enrollment

To add an insurance payer to your short Electronic Payer list, click on +Add New Insurance Company.

  • Your default clearinghouse will be listed at the top indicating the payer list you can access.
  • Click on the Company drop down box to select the payer.
  • Accept Assignment – defaults to “Yes”.  If you are billing as an out of network provider, you may change this to “No”.  
  • Special Overrides to Practice Setup – Any information entered in this section will “Override” any information entered in the Practice Setup.
  • Session Reminder Flags – This section is just a reminder field for you.  Any information entered will be available in the client session when you hover over “Insurance Note” in the upper right corner.  You MUST manually enter the information in the Client Session if you wish to have it on the claim, and after you enter it and save the session, the system will remember it when you enter the next Client Session.

Special Overrides to Practice Setup:

These are the overrides that can be done in the Insurance Company Setup:
  • Print Practice Name – This defaults to “No”, which prints the provider name as the billing provider name in Box 33.  If you need to use the Company name as the billing provider name, this drop-down box must be “Yes”.  If you are billing electronically, it will also send the claim through with the Billing Entity as an Organization.
  • Suppress Taxonomy – defaults to “Yes”, and the taxonomy number will not be on the claim.  If you are electronically billing Medicaid or an insurance payer that requires a taxonomy number, you must switch this drop-down box to “No”.  You must also enter the taxonomy number in the Practice Setup in the block next to the NPI number.
  • Use Office NPI – If an Office NPI is entered in the Office Locations Setup and this drop-down box is “Yes”, the Office NPI (from Office Locations) will print in block 32a.

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