This article explains how you can configure the payor details.  


After adding a payor, it needs to be set up effectively. This tab allows us to configure payors and manage necessary details.


How to Setup Insurance?

  • Navigate to the Settings tab (left). Go to Billing Setup and click on "Insurance Setup". 
  • Under the Insurance Setup list, edit your information as explained below:


Configuration:

Use filters such as Search Insurance, Is Electronic, CMS, and Active tabs to locate the insurance(s) under the list.

  1. Active: After adding the insurance, toggle ON the Active Switch to activate it. Toggle OFF to deactivate the payor temporarily from the list without removing it. 
  2. Is Electronic: Enable the electronic submission to the clearinghouse by toggling ON the "Is Electronic" switch. 
  3. CMS1500 31/32a/32b/33a/33b: Enter the required data in these fields to populate them on the HCFA form. 
  4. Save Payor Setup: After making changes, select the insurance(s) by clicking the checkbox. Click on "Save Payor Setup" (bottom left corner). 



How to Edit Payor?

Click the pen icon (right column) to edit further and adjust specific insurance information. Refer to the section below for detailed steps and images.


A pop-up Edit Insurance will appear, based on the insurance you selected. 


This section consists of two menus for configuring the selected insurance:


A. Box 33 and Box 32: 

In these tabs, you can add additional information for extra locations or specific needs.

Note: These boxes are not mandatory. If you need to send claims with different information in Box 33 & 32 than what is set in Facility settings, you will need to fill out these boxes.

    i. Features in Box 33:

  1. Facility/Individual: Choose whether claims should be sent with facility or individual information. Note: Selecting an Individual will include the provider's name on HCFA forms automatically. 
  2. Further Details: Add the Facility Name, Address, City, State, Zip, NPI, Taxonomy, and EIN if needed. 
  3. Save Box 33: Once you have made all the changes, click on Save Box 33.


    ii. Features in Box 32:

  1.  Add Details: Add the Facility Name, Address, City, State, Zip, NPI, Taxonomy, and EIN if you have different regions. 
  2. Save Box 32: Once you have made all the changes, click on Save Box 32. 


Insurance Access:

  1. Active: Enabling this toggle makes the payor active.
  2. Is Electronic: Toggle this switch to enable electronic submission to the clearinghouse.
  3. Concurrent billing Not Allowed: Toggle this switch to prevent concurrent billing in your facility. 
  4. Insurance Type: Choose the insurance type from the drop-down menu. 


Clubbing Settings:

  1. Don't Club: Toggle this switch if the claims shouldn't be clubbed. 
  2. Club with different POS: Enable this access to group the appointments with the same provider but different POS during claim generation. 
  3. Unclub with different providers: Toggle this switch if the appointments shouldn't be clubbed with varying providers during claim generation.


EDI Settings 

  1. Fill Box 17: Enabling the toggle will update Box 17 in the HCFA form.
  2. Fill Time Range Box: Enabling this toggle will make it the required code.
  3. Rend. Provider On Service Line: Enabling this toggle will populate the provider's name on the service line in the HCFA Form. 
  4. PWK Segment: 
  5. Tx Type/ Box 24J/ ID Qualifier: Add the Box 24J and the relevant ID Qualifier if needed. 

Once you have made all the changes, click on Save. 


Video Walkthrough

For a live demonstration of Insurance Setup.  See the below video: