Buttons - Edit/View Insurance Company

▪	Edit any information currently entered for this insurance.

▪	If changes are made to the contact person name or phone number, MEDENT will ask if the user wants to update all patient insurance records. If Yes, contact Support for the password. Note: This may take some time.

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▪	If all patients who have this insurance have the same employer, enter in the default employer name, address group plan name and group number.

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▪	2 digit codes assigned to identify the place where the service was performed.

Note:

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Most insurances will use the Standard HIPAA Place of Service Codes. These codes can vary by insurance company. The same code can always be entered in Charge Entry (e.g. 3 - Doctors Office). The value displayed to the right of the description is what will be transmitted electronically or printed on the insurance form. Click Set to HIPAA Place of Service to default in the Standard HIPAA Place of Service Codes.

▪	8) Skilled Nursing Facility = 31 admission date. Use the service date as admission date for this place of service

▪	Medicaid Vermont and Massachusetts use the standard 2-digit codes

▪	The following insurance companies use non-standard place of service codes:

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HIPAA

▫	Medicaid - NJ

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▪	It is no longer necessary to enter facility provider numbers. Insurance companies who previously required legacy facility numbers now require the facility NPI. The facility NPI is entered in the Facilities Master File

▪	If the provider #'s are being changed or a new provider is being added to the practice, please contact CCS.

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▪	If Provider #'s by Location is set to Y then the location lookup box will come up first. Select each location and enter the appropriate provider number. If the insurance company does not assign unique provider numbers, enter the tax ID without dashes.

▪	If Provider #'s by Specialty is set to Y then each provider will be listed with their specialties to allow entry of PIN #'s assigned for each specialty. The specialties must be entered in the Doctor Master File under each individual doctor.

Note: If entering a provider # for a non-doctor and the Recognize Non Doctor flag is set to N, the provider # will not be sent. Please contact CCS Support.

▪	Dr, Sp, and Dr name: Default from the Doctor Master File.

▪	CR: Indicates how a provider is credentialed with an insurance company. It will also determine whether or not a group NPI will be sent for this insurance company.

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G: Credentialed as a Group (Will send the Individual and the Group NPI Numbers) - If using G, for ECS claims the Provider Type Org in the control file should be set to 008). Many providers who did not previously bill as a group will need to bill that way for NPI. If they work for more than one practice, the group NPI will help the insurance company determine which practice to make payments to.

▫	I: Credentialed as an Individual (Will send the Individual NPI Number)

▫	N: Not Credentialed (Will not send the Claim, ECS selection will Error Out)

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AA: This field will only be accessible if the AA field in the Insurance Company Master File is set to y, Participation by Doctor. Indicate which providers AA for this insurance by placing a Y in this column. Note: If the insurance company is setup as Accept Assignment Y or N this field will be black and not accessible.

▪	HM: This field must be set to Y if the doctor is sending an Electronic Health Maintenance Inquiry submission to this insurance company.

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Provider No: Issued by the insurance company. If the insurance company does not assign unique provider numbers, enter the Tax ID without dashes. It is a good idea to still enter the legacy provider numbers even though we are past the 5/23/08 NPI deadline. Most insurances take the NPI and convert it back to the legacy number for processing. When you call the insurance companies, they will likely still ask you for this information so it is good to have it entered. Also, many companies still want to see the legacy numbers on paper claims. Note: The provider numbers must still be entered at this time for Medicaid NY and Aultcare. Medicaid NY is not yet accepting NPI only. Their projected NPI only date is 9/1/08. There is specialty programming in place to pull the Aultcare tax ID from this field as Aultcare assigns suffixes for the tax ID.

▪	Group Provider No: Only use this field if the insurance has assigned a group number to the practice. If billing with a Group #, the CR field should be set to G.

Note: There are options that will allow provider #'s to be copied from another insurance company, doctor, and/or location:

▪	Copy# from Ins Co / [F2]: Copy the provider #'s from another insurance company

▪	Copy# from Dr / [F3]: Copy the Tax ID from the Doctor Master File into the Provider No field

▪	Copy# from Loc / [F6]: Copy the provider #'s from another location

▪	Only Active Dr / [F5]: Click to view only the active doctors

▫	Include Deactivated Dr / [F5]: Click to view the full list of doctors, active and inactive.

▪	/ [F7]: Print a list of the doctors and provider #'s for this insurance company. Note: If Reports to Screen is set to Yes, then this will display to the user's screen. To have a printout, change this to No

See Also: Dr Provider Number Formats

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List of all referring doctors in MEDENT with the provider number for this specific insurance. Defaults from the Referring Doctor Master Files. Referring doctor provider numbers can be updated here or in the Referring Doctor Master File. Press [F2] to copy the referring doctor numbers from one insurance company to another.

▪	If the referring doctor does not have a Medicaid provider #, put in the referring doctor license number with the Medicaid type (e.g. 383838-060 (don't need the preceding 0's)) or use the doctor's Medicaid provider number (8 digits) only.

▪	If the doctor does not have a UPIN #, please see Medicare UPIN #'s

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State License/Certificate Numbers: Input in doctor file. Medicaid requires all providers to use a site-specific part-time clinic identification number for any service provided in a part-time site. This is a 13-digit number. This number will be transmitted to electronically record type 15, field 8, positions 26-38. Note: This applies ONLY to PART TIME MEDICAID CLINICS

▪	Category of Service Codes: 4-digit code assigned only by NYS Medicaid. When the insurance is setup as a workers compensation type this field becomes WCB Rating Code and the specialty code is entered here

▫	NYS Medicaid

▫	NYS Medicaid Clinic

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Locator/Address/Payee-Address Codes: 3-digit code assigned by NYS Medicaid and 4-digit code assigned by PA Medical Assistance to indicate address where services were rendered. When sending Medical Assistance electronically, the provider address code pulls from the locator code field in the Insurance Company Master File. Group address code pulls from payee code field in the Insurance Company Master File. If providers have different locator codes for various locations, then say Y to Provider #'s by Location so the different #'s can be entered. If they have locator codes for facilities, those should be entered under Facility Codes. If different providers have different locator codes for the same facility, then set Mult.Prv.#/Fac/Dr to Y under Other Options.

▫	Medicaid-NY (Managed Care Superbills)

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▪	Frm Break by Diag: Separate claims with different diagnosis codes (used for Paper/ECS claims)

▪	Frm Break by Date: Separate claims by

▫	D: Break by Day Note: Emdeon and IHA must be set to this.

▫	M: Break by Month

▫	Y: Break by Year

▪	Ask Clm Reference: Used for Medicare posting. Some secondary insurances want the claim reference number from the Medicare payment

▪	Documentation Req: Used when sending claims electronically and there is documentation required. Setup each CPT/HCPCS code requiring documentation.

▫	N: Company Doesn't Require

▫	Y: Company Does Require - Ask in Chg Entry Always

▫	y: Company Does Require - Ask in Chg Entry by CPT/HCPCS

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Mult.Prv.#/Fac/Dr: Does this insurance assign different provider numbers for each facility. This option in usually set to N. This option is mainly used for NY Medicaid. If the providers in a practice have different locator codes for the same facility, this option should be set to Y and the locator codes entered under Facility Codes.

▪	Send Org Name Only: This field is for electronic claims sent to Emdeon. The field will default to N. When set to Y, the individual doctor name does not send in the electronic file, just the organization name. For NSF, the BA0 19.0 is left blank. For ANSI, the 2310B loop is not sent.

▪	PHC4/SPARCS: This will flag the PHC4 or SPARCS reporting to include patients with this insurance company when you use the Create Quarterly Report File. Please see Export PA Cost Containment and/or Export SPARCS for full details on these separate modules.

▪	Facility Prt Opt:

▫	Y: Prints location address in box 32 if Place of Service is office. Will print facility information if service is performed in a facility.

▫	N: Prints nothing in box 32 if Place of Service is office. Will print facility information if service is performed in a facility.

▪	E/M Code in Sort: Put the E&M code first on the claim or transmit first ECS.

▪	Sort by price: No longer used

▪	Snd Prv Nam for ECS: Does this insurance require the provider's name on claims instead of the practice name (ECS claims)

▪	Default Patient Stat: Used for Medicare A and Medicaid Clinic. This will default into the status code field in Charge Entry.

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Modifier Control Opt: The MEDENT default variable will be option 0. The value selected will determine the way the modifiers are proposed to bill to the secondary insurance. Note: This option will overwrite #25 Modifier Control Option in Payment Posting Options. Medicare Modifiers QU and QB will not be carried over to the crossover company NO matter which option is set.

0.	Use modifier option as setup in Install

1.	Use modifiers for original charge for crossover claims to this company

2.	Use modifiers from fee schedule setup for crossover claims to this company

3.	Use no modifiers for crossover claims to this company

▪	Ord Dr for PT/OT/ST:

▫	None: Will not ask for the ordering doctor for any of these specialties.

▫	PT, ST, and OT (All): Asks for the ordering doctor for each of these specialties.

▫	PT Only: Asks for the ordering doctor for Physical Therapy only

▫	OT Only: Asks for the ordering doctor for Occupational Therapy only

▫	ST Only: Asks for the ordering doctor for Speech Therapy only

▫	PT and OT only: Asks for the ordering doctor for Physical Therapy and Occupational Therapy

▫	PT and ST Only: Asks for the ordering doctor for Physical Therapy and Speech Therapy

▫	OT and ST Only: Asks for the ordering doctor for Occupational Therapy and Speech Therapy

Note: This option overrides the fee schedule for Sup Req. If the fee line is set up to send the rendering doctor, the ordering doctor information will be sent.

▫	PT Physical Therapist specialty codes: CI, CJ, CR, CL, CM, CN, CO, CP, CQ, CS, CT

▫	PT Assistant Physical Therapy specialty code: CU

▫	OT Occupational Therapist specialty codes: C7, C9, CA, CB, CC, CD, CE

▫	OT Assistant Occupational Therapy specialty code: CF

▫	ST Speech Therapist specialty code: DD

▫	ST Assistant Speech Therapy specialty code: DC

▪	ECS Eligibility: Default is N. Set to Y if insurance company has electronic eligibility

▪	ECS Claim Status: Default is N. Set to Y if insurance company has ability to do electronic claim status.

▪	ECS Request Med Doc: Default is N. Set to Y if insurance company receives claim status requests for medical documentation and sends it.

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Send Practice NPI Only: Default is N. Set this to Y if the insurance company wants to receive only the practice (group) NPI. If this is set to Y, the rendering doctor's NPI number will not be sent. If set to Y, the Provider Type Org in the control file should be set to 008. Note: If a practice needs to bill only the practice NPI for labs and the lab is a location, this field should not be changed as it would affect all claims and not just the labs. All Medicares as well as PA Medical Assistance have been programmed to send only the practice NPI when the place of service is sending as 81 (MEDENT pos 11) for independent lab. Medical Assistance is also programmed to send only the group NPI when billing place of service 72 (MEDENT pos 28) for rural health clinic.

▪	Group Taxonomy: The default is N. This should not be changed without first consulting CCS. This is only needed in rare circumstances.

▫	N - None: The insurance company does not require a group specialty code and none will be entered at Charge Entry.

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D - Default: The insurance company requires a group specialty code. At Charge Entry, MEDENT will first look to see if a specialty code has been entered for the location. If so, that specialty code will default into the charge record. If not, MEDENT will then look at the practice and default the first specialty code entered.

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C - Choose at Charge Entry: The insurance company requires a group specialty code. At Charge Entry, MEDENT will first look to see if a specialty code has been entered for the location. If so, that specialty code will default into the charge record. If not, you will get a popup of the codes listed in the practice and will need to choose one. Note: If an insurance company that is setup with this variable is the secondary/tertiary on a patient's account and the insurance company before it is autoposted, the payment will get Autoposted. However in the last section of the Exception report there will be the following msg: Payment made, next insurance requires a group taxonomy code. MA01 claim may not have the correct group taxonomy code. Review cl MA07 and change the group taxonomy code if needed. The office will have to manually attach the Group Taxonomy code before billing on to the insurance.

See Also: Group Taxonomy Codes

▪	M'caid, M'care or BS Facility Claims: Only turn this option on for Medicaid Clinic, Medicare A or Blue Cross facility companies. Please contact Support for more information.

▫	Y: Submitting Medicaid/Medicare Clinic Claims

▫	y: Submitting Medicare Clinic CORF Claims Note: Only uses Occurrence Code 28 for PT's

▫	N: No Medicare/Medicaid Clinic

▫	If Y or y is selected, an additional question will appear asking Use ICD9 Principle Procedure Code for Insurance Printing? The default is Yes. Answer No if the CPT4 Principle Procedure Code should be used for insurance printing. Currently, Medicare and Excellus BS require the CPT4 codes.

▪	Use Practice Address for ECS Claims: (ECS only)

▫	If set to Y and

▫	Provider #'s by Location = Y: Send location address as rendering address and practice address as bill to address.

▫	Provider #'s by Location = N: Send Doctor address as rendering address and practice address as bill to address

Note: If this is set to Y, there must be a practice # entered in the Doctor Master File. If a practice number is not entered, you will receive selection errors for invalid practice address.

▫	If set to N and

▫	Provider #'s by Location = Y: Send location address as both rendering and bill to address

▫	Provider #'s by Location = N: Send doctor address as both rendering and bill to address

▪	Use Control File Address for ECS Claims: (ECS only) This option affects only ECS billing to the Emdeon clearinghouse.

▫	If this option is set to Y, then the billing address in the electronic data file will be the submitter address entered in the Emdeon control file.

▫	Please be sure control file address is correct and up to date.

▪	CPT/HCPCS Covered if Policy# Starts With:

▪	Send only this Insurance Co. info:

▫	Y: Only this insurance's information will be transmitted when submitting claims electronically

▫	N: Will send another insurances' information where the patient has on account

▪	Use Patient Doctor for Ins. Process: Pull the doctor from Patient Information for ECS instead of the doctor the charge was billed out to. Contact Support for password.

▪	Always set Emdeon COB fld to NO:

▪	Interest Payment Account #: Defaults the interest account setup in Payment Posting Options > #6 Default Interest Acct #, for interest payments if blank.

Note:

▪	To have the interest from this insurance post to a special account, input account number.

▪	To have the interest from this insurance post to a special account, input the account number.

▪	Name all the interest accounts similar so they will be easy to look up by name later. For example, Last name: INTEREST ; First name: Community Blue. This way when INTEREST is typed in all the accounts that have the same last name of interest will appear and the desired one can be selected.

▪	UB04 Require Admission Hour: If the insurance company requires the Admission Hour to print on the UB04 form in block 13, set this flag to Yes. This will prompt the Admission Hour options in Charge Entry when the Admit Date is being filled in.

▪	Use Patient RDR for Ins. Process: Pull the referring doctor from Patient Information for ECS claim

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Combine Crossover Chrgs into 1 CPT/HCPCS: For multiple CPT/HCPCS's, MEDENT will combine the approved amounts and paid amounts into 1 line item to be submitted electronically only to the secondary Insurance. Contact Support to use this option. Note: If Y, under the Related CPT/HCPCS section of the primary CPT/HCPCS codes that are to be combined into one code, input the code to send under.

Example: Under House Code 92083TC and House Code 9208326 input 92083 for the Medicaid fee schedule (under Related CPT/HCPCS). 92083 is the code the other codes should be rolled into for electronic submission to Medicaid. 92083 must to be setup as a CPT/HCPCS Code. Important: This is only for electronic submission.

▪	Prt Appr/ExpAppr Amt if Diff (Autopost):

▫	Y: Show on Exception Report

▫	y: Show on Exception Report and Ask Appr Amt when Posting

▫	N: Dont Show Differences on Exception Report

▪	Accept Personal Payments:

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No: A warning message appears when a payment is posted to a charge out to Insurance in Personal Payments or Accept Assignment Payments. The message tells the user that personal payments should not be entered for this company. The user then answers a Yes/No question to determine if the personal payment will be applied to the charge or not.

▪	Send/Print Units or Minutes: Insurance Companies differ on what they want sent for anesthesia, Minutes or Units. This field allows us to send each Insurance Company what they want. This field is used by ECS and Insurance form printing.

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Which Medicaid Clinic Rate Code: This field will determine which Medicaid Rate Code Field is sent to Medicaid Clinic. This will default to 1. This should remain 1 unless a different rate code needs to be sent for the same house code. The two different rate codes cannot be used for the same Insurance Company. If two are needed, there would need to be two Medicaid Clinic Insurance Companies. Different rate codes are sometimes assigned for different specialties. The Medicaid Rate Code is in CPT/HCPCS Code > Additional Information.

▪	Ask Specialty In Charge Entry: This question affects Doctors that have multiple speciality codes.

▫	Y -Popup Box For Specialty Choice if Doctor Has Multiple Specialties: This is the default.

▫	N -No Popup Box, use Primary Specialty: In Charge Entry the pop up box to select the specialty code will not come up and the primary specialty code will be used for the charge.

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Company Uses EFT: This flag is used to alert the Daysheet if an Insurance uses Electronic Funds Transfer to enable the poster to keep the EFT posting separate from the regular deposit. If this flag is set to No, the Daysheet will not be able to separate the postings. Note: This option is for Manual payments and Autoposted payments.

▪	Send Location NPI if Present: If sending a group NPI, this field will determine if the group NPI is pulled from the location or practice name.

▫	Y: Send location NPI as the group NPI. If no NPI is entered in the location, then the NPI from the practice name will send.

▫	N: Will not look at the location for NPI. The NPI in the practice name will send as the group NPI.

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Print NPI Only: Default is No. If this is set to Yes for Insurance printing, only the formattable items for NPI numbers will print. The Insurance claim form will no longer print any provider numbers for Referring Doctor, Rendering/Supervising Doctor, facility provider number, or group provider number.

▪	If Insurance Company only uses specific labs.

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▪	Referral (Prior Auth) Required:

▫	N: Company Does Not Require Referral. If set to N, you will not be able to add a referral to a charge being billed to this Insurance.

▫	Y: Company Always Requires Referral. Prior approval is required for All CPT/HCPCS Codes.

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y: Controlled by Individual CPT/HCPCS's at Fee Schedule. Prior approval is controlled at CPT/HCPCS Code level. Setup is in Charge Entry Standard Options > #32 Always Ask Referrals If By CPT/HCPCS. This controls when the user is asked for a Referral while entering charges. Note: Having a y on the Insurance Company Master and an N to Referral Required on the CPT/HCPCS Code will send a referral if attached to a claim. However, MEDENT will not edit for no referral if setup this way. If an Insurance only needs a referral once in a while, set to y here and leave as N at the CPT/HCPCS Code. This will allow the referral to be attached to the claims that need one, but not error out for those that don't.

▪	Referral (Prior Auth) Required for Crossover: Is referral number required for crossover claims

▪	Default 'NONE' for Referral Number: Default "NONE" for the referral number when adding a referral

▪	Default # of Days for Referral: Enter the default value for the number of days the referrals will be effective

▪	Ask for Initial Consultation Referral Number: In Charge Entry ask for the initial consultation referral number

▪	Referral Form Number: Form number used for this company's referrals. Form must be setup in Master File.

▪	Send Referrals Electronically: Can referrals for this Insurance be sent electronically. Note: This is not implemented at this time.

▪	Referral CLHouse: If Y for Send Referrals Electronically, which Clearinghouse do referrals process through. Note: Not implemented at this time

▪	Warn if 'Referred to' Dr not Insurance Plan Member: MEDENT warns the user that the Referring Doctor chosen is not a member of this Insurance (from Referring Doctor Master File)

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Default # of Visits for Referral: User can set the default value for the referral visit counter when adding a referral. The # of visits will default to "UNLIMITED". Then the user can change it from "UNLIMITED" to 10, 20, etc. <Blank> Is also an option. This will force the user to select a value for the original and remaining visit fields when adding a referral for that Insurance Company.

▪	View the log of all activity for this item.

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If an Insurance has specific requirements for policy number format (e.g. suffix, prefix, length of policy number) input this information here. When adding or editing insurance information, MEDENT will prompt if an invalid format for this Insurance has been entered. Note: These are not mandatory fields.

▪	Insured Party's SS# used For Policy ID:

▫	Y: When adding this Insurance on a Patient's account the insured's SS# will default as the policy number for all covered members on the account.

▫	N: MEDENT will not default anything and the policy number will need to be manually entered.

▪	Patient's SS# Used for Policy ID:

▫	Y: Will default each Patient's SS# as their unique policy number

▫	N: MEDENT will not default anything and the policy number will need to be manually entered.

▪	Maximum Id Length: MEDENT will not allow a policy number to be entered that exceeds this length.

▪	Minimum Id Length: MEDENT will not allow a policy number to be entered if it does not contain this length.

▪	Use Suffix: If Y, the appropriate suffixes will need to be entered for the insured, spouse, and/or account member. When adding Insurance to an account, the appropriate suffix will be added to the policy number.

▪	Insured Suffix: If this plan has a specific suffix that is assigned to the insured (e.g. HMO's usually assign 01 for the insured).

▪	Spouse Suffix: If this plan has a specific suffix that is assigned to the spouse (e.g. HMO's usually assign 02 for the spouse).

▪	Account Member Suffix: If this plan has a specific suffix that is assigned to the account member (e.g. HMO's usually assign 03 for the next account member).

▪	Use Prefix: If Y, and there is a prefix entered in the Most Common Prefix, then that prefix will default after the policy number when adding this Insurance to a Patient's account.

▪	Most Common Prefix: Default an Insurance's common prefix in the policy number.

▪	Acceptable Prefix: Can add up to 15 acceptable prefixes for this plan. When multiple prefixes are used, there is a pop up selection box available when adding Insurance to a Patient account.

▪	Default Policy ID: Answer Yes or No to default policy ID when adding dependents

▫	Yes: Defaults the policy ID of the primary member

▫	No: Nothing defaults.