Insurance Code - A 1-5 alpha-numeric code that is the Insurance. This should be unique across all insurance companies entered.

Insurance Name - The full name of the insurance company.

Address Fields (optional) - The address for the insurance company. This address is used on the CMS1500 and EDI.

Phone / Fax (optional) - The numbers for the phone and fax of the insurance company.

Has Related Contact (optional) - If checked on the creation of the Payment Source, a contact will be created in the system that is linked to this insurance company. This is useful if there are forms that need to be created and tied back to an insurance.

Pin Number (optional) - The Pin number for the insurance company. Not used directly in the system.

Group Number (optional) - The group number for the insurance company.

Payer ID - If you are billing in the system, the Payer Id needs to be the correct id for the insurance company. (https://access.emdeon.com/PayerLists/) can be used to find the correct payer id. If you add multiple insurances with the same payer id, all but 1 will need to receive payments from (explained later)

Copay Frequency - This is used to determine client liability for users that have a billable service with this insurance company.

 Visit: Each visit the copay will be calculated

 Week: Once a week the copay will be calculated

 Month: Once a month the copay will be calculated

 Year: Once a year the copay will be calculated

Batching Scheme - When items are batched up from the proofing screen, this is what determines what batch they are added into.

 Undefined: Will throw an error when batching up a claim "No Batching Scheme selected for payer."

 FormGroup: If the organization is set up to select a FormGroup with calendar items, You can batch claims by FormGroup

 Day: Batches will contain claims for the day

 Week: Batches will contain claims for the week

 Month: Batches will contain claims for the month

 BiWeekly: Batches will contain claims for Week 1 and 2 for the month

 QuadWeekly: Batches will contain claims for Week 1, 2, 3, and 4 for the month

Batch by Most Recent Trigger - If checked, batches will only be created when a trigger appointment is found. An example would be that service can not be billed unless a particular service is done. If the system is set up to do that, batches will be based on this trigger.

Deposit Account - When payments are made by the insurance company (EOB), this is the account in the accounting system that the funds are deposited to.

Write off Account - Any written off amounts from the insurance payment will be deposited here. It is recommended that the account is not the same as the Deposit account. For example, an account called "Contra Income" would be a good account for write off.

Receive Payments From -  The Payer Id is the identification number assigned to the payer by Emdeon for electronic submission of data. When a payment comes from the insurance company, it will be identified by the Payer Id. If you have multiple payers set up with the same Id, there is no guarantee that it will post under the correct insurance. Using Receive Payments From will define what insurance company is to be the "master" when posting and receiving payments.

Waterfall CPT codes from payer - Instead of setting up the same CPT codes under every insurance company, you could set them all up under one "master" insurance, and have it waterfall from other companies you set up. If you need to overwrite, or add a unique CPT code that can be done under the insurance company even if it is waterfalling.

Use codes not specified here from payer - Similar to the waterfall CPT codes, you can set up a master payer to define Insurance codes.

Electronic Eligibility Check Payer - If a payment source is set up for eligibility, you can use the same settings as that by selecting the payment source here

Type - Used in the main grid. Categorizes the payment source.

Print CMS-1500 - If ticked, you will have the ability to print a CMS 1500 form from the Third Party Billing screen. A CMS-1500 Layout must be selected for the printout to work. Custom layouts can be built to handle differences with specific payment sources.

Print UB-04 - If ticked, you will have the ability to print a UB-04 (CMS-1450) form from the Third Party Billing screen. A UB-04 Layout must be selected for the printout to work. Custom layouts can be built to handle differences with specific payment sources.

Create EDI - If ticked, you will have the ability to create an EDI file from a batch on the Third PArty Billing screen.

    Sender - (required) The sender definition.

    Receiver - (required) The receiver defintion.

         * Default setup is with Emdeon values. Custom Sender/Receiver information can be added if EDI needs to be sent to another clearing house.

    EDI Setup File - (required) This is the definition of what data goes in each LOOP / SEGMENT in the EDI file. Setups can be modified under the Bill Setup page, but normally are modified by Unicentric.

Print Custom Report - Reports created under the Fiscal department can be linked to the Payment Source, and show up when viewing a batch. Tick the checkbox next to the report to link. Un-tick to unlink.

Invoice # For Report - If using FormGroup batching, an invoice number can be assigned / displayed on the report if this is ticked.

This will save the payment source.

Rates, Service Offerings and Insurance Codes can also be added when creating a new payment source, and will be explained later in this article.

Active Date - This dropdown defines the instance of procedures that show in the grid. When a set of rates are expired a new entry will be added. The "Current" option will display the current active procedure rates.

Add - Clicking this button will allow you to add a new rate

Clone All - Clicking this button will clone all rates in the grid, expire the previous, and update the active date on the new. This is useful when the payer changes the rates for all services (example: 5% increase). Instead of editing each rate individually, you can clone and update the rate in one step.

Expire All - Clicking this button will expire all the rates in the current grid. Rates can not be used for services outside the active - expired range.

Edit - Edit the rate

Clone - Clones and expires the single rate

Expire - Expires the single rate.

Active Date - The date that this insurance rate is active. This date corresponds with the date of the calendar item.

Procedure Code - The procedure that you are defining this rate for.

Units Per Hour = How many billable units there are per hour. If the rate bills in 15 minute increments, then you will enter 4 units per hour

Max Units - The maximum number of units that can be billed for this procedure. If billable units is greater than max units, billable units will equal max units.

Calc Method - The method that is used for the calculation for the rate

    Flat Fee: This procedure will have a rate that is a set price regardless of the duration

    Units: The calculation is based on the billable units

    Range of Flat Fees: Similar of Flat Fee, but duration will determine what flat fee is used.

    Round to the Nearest Unit: If units per hour is 15, and the duration of the calendar item is 10, it will round to 15.

   Actual Duration: actual duration is used to determine the rate used.

NOTE: The calculation used when using Actual duration is (minutes * rate). When entering the rate for the CPT Code, enter the minute rate versus the hourly rate.

   Non-Billable: appointment is non-bilable

Billing Increment - If a "Unit" Calc Method is selected, you can choose the billing increment here.