A Group is used to define a business entity or individual within a clinic. This information will be useful for populating information to the CMS 1500 form. Newly added Groups may contain more than one provider, but a provider may only be associated with one group.
Creating a Group and associating a provider with a Group, will cause the group information to default as the Provider's Pay To/Billing Provider information, with each insurance company. If there a specific Insurance Company that recognizes a different Pay To (or Group) for a particular Provider, the Group information can be overridden in the Insurance Company dialog, as needed.
It is highly recommended that you set up your Groups after your Facilities, as it will greatly streamline your setup of insurance companies later in the setup process. Note: It is recommended that even if a Provider in the clinic is his/her own group, you can setup a single provider as a group. The Group information will be the default Pay To Provider for the Provider. All in all, a group can represent a single doctor or a group of doctors. It is really just who the billing entity is for the Provider.
- Contact Information: Enter the basic demographic information for the group. (Name, Address and Phone) Include 9 digit Zip Code. Note: Address must be a street address. If Pay-To address is a PO Box, etc., that information will be entered in section 5.
- Select Person or Non Person Entity type
- ID Numbers: Enter the appropriate ID for the group. Indicate either the EIN or social security number and add the number. Enter Billing NPI number.
- Electronic: Select Mutually Defined - ZZ for the identifier for the Submitter ID. This ID is how TriZetto identifies who is submitting the claim file. The ID field will be your 4 digit Site ID code provided to you by TriZetto. Enter Billing UPIN Enter Billing State License
- Pay-To Address: If payment is sent to an address other than the street address in Contact Information, enter that address here. Include 9 digit Zip Code.
- Paper Claims Legacy ID: (Optional) Select from the drop down to indicate a particular ID/number, if your state requires a particular ID on every claim. For instance, if your state requires the Taxonomy Code, you can enter the taxonomy identifier and code, and the information will go in the legacy field of every claim, along with the NPI number. If you are not aware that a particular ID is required for every claim for your state and payer base, other than the NPI, you may be able to ignore this field.
- Additional IDs: When setting up a brand new system, you can ignore the Insurance Information section, initially. You will have to have your insurance companies setup first, before you can really take advantage of this field. Once you have finished the setup process, and need to add additional IDs required for a particular insurance company, you can change that information here at the group level, if needed. *To create an additional ID for a specific insurance company (for your group), you will click the Create New button (with the green + sign). Search for the needed Insurance Company. Click Select. Electronic Claims: Add the additional ID required by the selected insurance company. If UPIN or State License is required, you can click on the '+' to automatically add the ID from step 2. Paper Claims: If a legacy ID is required in addition to referring provider NPI for paper claims, use the drop down to select the legacy ID Qualifier followed by the number and then Click Save.
- Legal Authenticator: Complete this section for exporting QRDA 1 files. Otherwise, leave blank.
- Click the Save button to save changes.
Click here for more information from the Practice Management User Manual for detailed information for set up.