This article explains how you can configure the payor details.  


Video Walkthrough

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


The added insurances in TherapyPM for the facility can be configured using the Insurance Setup option in Settings Tab. 

 

  1. Select - You can select all of the insurances you need to edit at once.  
  2. Insurance Search Bar - Search for insurance(s) by the fields in the search bar.  
  3. Is Electronic - Enables the capability of generating EDI, or instead developing a paper claim.  
  4. CMS1500 31/32a/32b/33a/33b - Manually enter data here to populate on the HCFA. 
  5. Active - Toggle Insurances to be temporarily turned off if necessary, without removing them from the system 
  6. Edit Payer - Adjust even more specific insurance information. See the section below for steps and images.  

 

Edit Payer Information  

 

The edit Payer section has 3 sections for configuring the selected insurance:  

 

 

  

Box 32/ Box 33: If necessary, add facility information in case of additional location.  

  

                                                                                                                                                                                                 

More insurance settings:  

1) General Settings:


 

  1. Active toggle - Toggle Insurances to be temporarily turned off if necessary, without removing them from the system.
  2. Is electronic toggle - Enables the capability of generating EDI, or instead generating a paper claim.  
  3. Concurrent Billing Not Allowed - When this is turned on, concurrent billing will be blocked and claims will be split based on overlapping times.
  4. Enable Supervision validation - When this is turned on, for each 16 hour of direct therapy (97153) 1 hour of supervision (97155) will be required to generate batch

 

 2) Clubbing Settings: 

 

  1. Don’t Club – Use the toggle if do not want to perform clubbing.
  2. Club with different POS – Group the appointments with the same provider with different POS during claim generation.
  3. Unclub with different providers - Do not group the appointments with different providers during claim generation.
  4. Clubbing validation - When enabled, clubbing validation checks for related sessions that should be billed together. If you attempt to process a claim while a related session is still in a “Scheduled” status (i.e., not yet rendered), the system will show an alert.

 

3) EDI Settings 


 

  1. Fill Box-17 - Select the toggle to fill box 17 in EDI.
  2. Fill time range box - Click to fill time range box.
  3. Rend. Provider on service line - When enabled, rendering provider details will be populated on service lines.
  4. Treating Provider as Rendering Provider - When enabled, the treating provider will be automatically set as the rendering provider.
  5. PWK segment - When enabled, the PWK segment will be included.
  6. Disable 8 Minutes Rule - When enabled, the 8-minute rule will be disabled for unit calculations, and units will be rounded down.  
  7. 24H Box (EPSDT) - When switched on, Box 24H Qualifier (EPSDT) will be sent as selected. It can be set using the Reference ID and Reference Qualifier fields.

 

4) Tx Type/ Box 24J/ ID Qualifier - Overrides Box 24J and ID Qualifier in the HCFA