The following instructions are to setup an insurance company with appropriate data for submitting claims.
- Access Admin > Vendors/Partners > Insurance Companies. Ensure the following fields have been populated for each insurance company.
- Insurance Company Name.
- Address (only required if not sent electronically).
- Classification: This field is required for paper claims and pertains to Box 1 of the HCFA form. Please complete accordingly. See Example
- Claim Submission: If claims for this payer will be sent electronically from RevolutionEHR to the clearinghouse, select "Electronic." If the claim will be sent another way (not through the clearinghouse) select either "mail or print." These selections allow you to manually mark these claims as submitted. For any payer that you do not want to create a claim, select "None."
- Payor ID: If you are filing electronic claims through Trizetto, a Payor ID is required. If you are using Apex, they will communicate to you whether or not a payer id is required.
- Claim Filing Code: This is required for electronic claims.
Claim Filing Code Payer Claim Filing Code Indicator Medicare, Railroad Medicare, Medicare Advantage Plans, DME, anything "you think of" as Medicare MB-Medicare Part B Medicaid, Ucare, anything "you think of" as Medicaid MC-Medicaid Champus CH-Champus Blue Cross Blue Shield BL-Blue Cross/Blue Shield Tricare OF-Other Federal Program All other payers; e.g. UHC, Cigna, Aetna, UMR CI-Commercial
- Participating Practice: If you accept assignment, check the participating provider checkbox. If you do not accept assignment, you will not check this box and the patient will receive the insurance check. This is Box 27 on the HCFA form.
- NPI Only only claims: If this is checked, then box 24J and 33a will only display the NPI. It is our recommendation this box be checked.
- User Rendering Provider as Referring: If checked, this will automatically set the rendering provider as the referring provider on each claim. This is HCFA Box 17. It is our recommendation this box is checked for your Medicare payer.
- Remove matching service facility NPI: This field is for special case use. It is our recommendation this be left unchecked. If you feel this applies to your practice, call customer support for assistance.