Insurance Company Setup for Claims

The following instructions are to setup an insurance company with appropriate data for submitting claims.

Instructions

1. Access Admin > Vendors/Partners > Insurance Companies.
2. Click the + icon, and complete the following required fields. Note: If the insurance company is already listed, open and verify the following fields have been populated for each insurance company. 
   • Name: 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."
   • Payer ID: If you are filing electronic claims through Trizetto, a Payer 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, do not check this box and the patient receives the insurance check. This is Box 27 on the HCFA form.
   • NPI Only on claims: If this is checked, then box 24J and 33a only display the NPI. It is our recommendation this box is checked.
   • Use rendering provider as referring provider: If checked, this automatically sets 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 is left unchecked. If you feel this applies to your practice, call customer support for assistance. 
3. Click 'Save.'
4. Log out and log in to see the changes associated to the setting.