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Insurance Carriers

Insurance Carriers

 

See Also:

Provider Carrier Overrides

 

Insurance carriers, or payers, are the entities to whom you submit claims. You can actually have multiple carrier records for a given insurance company when, for any reason, they must be dealt with differently or separately.

 

General tab

 

 

Name

Enter the insurance carrier or company name.

 

Branch

To identify different carriers for the insurance company, you can enter a branch name. This can be any name that makes sense to you, even a number. The branch name is used on screens so you can tell one carrier from another but it doesn't print on claims.

 

Address

Enter one or two street address lines, a city, state abbreviation, and zip code. The address will print at the top of insurance claims.

 

Contact

If there is a contact person you work with, enter his or her name here.

 

Telephone

Enter telephone area code, number, and extension for voice calls and an area code and number for faxes.

 

Active carrier

When checked, the carrier will appear on the default carrier's list and will be available for selection when you add patient insurance.

 

Notes

Enter any notes you need when working with this carrier.

 

 

CMS-1500 tab

The top section of this tab are settings used to fill the CMS-1500 claim form.

 

 

(Insurance Type) [Box 1]

Indicate the type of health insurance coverage applicable to this claim by placing an X in the appropriate box. Only one box can be marked.

 

Insurance Plan Name or Program Name [Box 11c]

Enter the insurance plan or program name of the insured. Some payers require an identification number of the primary insurer rather than the name in this field.

 

Accept Assignment [Box 27]

The accept assignment indicates that the provider agrees to accept assignment under Medicare or other insurance.

 

Print carrier name/address block on CMS-1500.

The top section of the CMS-1500 form is usually used for the carrier name and address. If you don't want the address printed, remove the check.

 

Blank currency amounts when zero

Currency amounts appear in boxes 20, 24f, 28, 29, and 30. To print nothing, not even a zero, in these form boxes, check this box. Other wise 0.00 will be printed.

 

Show box 24j IDs if they are the same as the IDs in box 33 [Box 24j]

The IDs in box 24j identify the performing or rendering provider. Those in box 33a and 33b identify the billing provider. These might be the same or different. Ordinarily, when the the box 24j IDs are the same as those in box 33, they are printed in both places. Some payers, however, don't want the IDs to print in box 24j if they are the same as in box 33. If this is the case for the current carrier, remove the check in this box.

 

Patient Payments [Box 29]

Insurance payments to the listed services are always totaled and included in box 29. This selection determines whether patient payments should be included as well.

 

Illegal Characters

Certain characters should never be printed on CMS-1500 insurance claims. This field is the list of those disallowed characters.

 

Print Characters As

When the program encounters one of the illegal characters, this setting determines whether the character is replaced with a blank space or whether it is removed entirely, closing up the space.

 

Ignore provider secondary IDs

Many carriers do not want to receive provider secondary IDs when the NPI is present. Check this box to blank the secondary IDs when there is a corresponding NPI.

 

 

See Also:

Provider Carrier Overrides