• To create and print a CMS / HCFA 1500:
1. Follow the menu item sequence … File | Insurance or click on Insurance Icon on the menu toolbar.
2. The Search Insurance Screen is displayed. To add a new Insurance record click the Add Button. To search for an existing Insurance, provide one or more pieces of information that can be used to identify the Insurance record and then click the Search Button. When the search is complete, all insurance records that meet the search specifications appear in the grid data list located just below the search criteria. The result data grid has several columns that allow a positive identification to be made. If the patient insurance you are trying to find already appears in this list, its information can be retrieved by highlighting their row then clicking the Select Button or just double-click the desired record.
• Patient Tab:
3. Now the Patient Insurance Record Screen is displayed and you can enter all the relevant information belonging to the patient’s insurance.
4. You can also automatically transfer Patient and Order information to the insurance record. To transfer patient information for whom no Order exists click the Link Patient Button then search and select the patient from the Search Patient Screen. Once the patient is selected all their relevant information from the patient module will be transferred.
5. To transfer patient and order information, click the Link Order Button then search and select the Order from the Search Order Screen. Once the order is selected all the relevant order and patient information from the patient and order module will be transferred. Only charges that have Procedure code associated to them will be transferred from the order to the insurance claim. The charge for the item is the retail price from the inventory setup for the item.
6. In the Patient Tab, enter the patient demographic and insured information as you would on the CMS / HCFA 1500 form. This information is transferred automatically from the patient module if you linked this insurance record with the Patient or Order record.
7. Click the Select Primary Insurance Button to select the insurance to bill.
• Referring Provider Tab:
8. In the Referring Provider Tab, enter the insured, physician and patient diagnosis information as you would on the CMS / HCFA 1500 form. This information is transferred automatically from the patient module if you linked this insurance record with the Patient or Order record.
• Charges Tab:
9. In the Charges Tab, enter the items and their charges as would on CMS / HCFA 1500 form. This information is transferred automatically from the Order Module if you linked this insurance record with the Order record. All the items ordered from the Order are added here. The Place of Service is defaulted as 11 (Office). Some Medicare services require POS to be 12 and this can be setup to default to 12 under Company Information Settings Tab. Units defaults to 1 when adding charges manually. When linking the insurance with the order the units are calculated based on the charge and same procedure code linked to inventory.
e.g. if an order has two lenses with V2100 (linked through inventory) it will be added as a single-line with 2 units.
10. Charges are always billed at full retail price instead of what the insurance owes even though we are only expecting the insurance portion of the payment.
11. The Service from and to dates are defaulted to the order item date or today if you are adding a new record. You can always overwrite any of the information that is automatically entered.
12. The Modifier Field is editable so you can enter codes not in the modifier setup or multiple modifier codes.
13. In the Accounting Section, there are some extra fields added for you to keep track of the status of insurance. It also shows accounting information from the Order module. Created Date field defaults to the date the claim is created. Created Date, Submitted Date, Submitted checkbox option allows you to search and create list of Batch Claims to be printed or electronically submitted.
14. If your practice is not a group practice click the 24J=33 Button. If it is a group practice select the rendering provider from the 24J drop-down list otherwise it defaults to the provider information in field 33.
• Qualifiers:
|
Provider Taxonomy |
ZZ |
|
State Industrial Accident Provider Number |
X5 |
|
Social Security Number |
SY |
|
Provider Plan Network Identification Number |
N5 |
|
Location Number |
LU |
|
Provider Commercial Number |
G2 |
|
Employer Identification Number |
EI |
|
CHAMPUS Identification Number |
1H |
|
Provider UPIN Number |
1G |
|
Medicaid Provider Number |
1D |
|
Medicare Provider Number |
1C |
|
Blue Shield Provider Number |
1B |
|
State License Number |
0B |
• Provider Tab:
15. In the Provider Tab, select the provider. Provider information in Box 25 and 33 is automatically filled once the provider is selected. Default Provider can be automatically populated from the doctor linked to the order and the default provider specified for the doctor.
16. The patient’s insurance claim information is now in the database; click the Preview Tab to view the information how it would appear on the CMS/HCFA 1500 insurance claim form.
17. If you going to be printing CMS 1500 claims you will need to align the printer to correctly print the data in its proper fields. To align the printer click the Printer Alignment Button. Typical settings are Left Margin of .300 and Top Margin of .325.
18. To print the fields captured here to the preprinted CMS / HCFA 1500 form, insert the preprinted CMS / HCFA 1500 form into your printer paper tray, select the Print Image Radial-Button then click Print.
19. Preview Button allows you to preview the insurance claim in Print Image Format.
20. To submit electronic claims choose the appropriate format (Print Image, ANSI 837, or Eyefinity VSP/Non-VSP) then click the Electronic Button. This will prompt you for the location where the file should be created or will tell you the location where the file was created. You can then submit the claims electronically through the clearinghouse website.
21. Click Save Icon on the toolbar to save the record.
• Preview Tab:
22. Preview tab shows the claim form with the data filled. It is only available for display purposes. To print the form click the Preview Button under Provider Tab.
NOTE: For ANSI Claims submission, specify clearinghouse information under Company Information setup.
See Also: