Add new Insurance Companies, Edit existing Insurance Companies and Associate Providers to Insurance Companies when submitting Insurance Claims.

1. Add a new Insurance Company.

2. Edit an existing Insurance Company.

3. Delete an Insurance Company.

4. Click inside the blank grid directly below column headers and begin typing to search by name, City, State, etc.

1. Click the Add New Company icon to open the Edit Insurance Company dialog.

2. Type Insurance Company information including:

Type-This will be used to determine which box to check in Block 1. on the CMS 1500 form.

Group Provider (Legacy)- If the Insurance Company requires a Legacy number in addition to a NPI number, Type the Group/Pay To number here.

Fee Schedule (Legacy)- This is for information purposes only, any Legacy Fee Schedules previously assigned to this Payer.

Fee Schedule- Use the Drop Down option to select a Fee Schedule from the list in Fee Schedule Maintenance, or leave blank and it will use the Default fee schedule

3. Check the box if applicable:

Active This box will default to active. Click to remove check mark if the Company becomes inactive/no longer a valid Insurance Company.

Show Legacy ID If checked, the Legacy numbers entered in the Company information will be included on all claims.

Default Electronic Check box if claims for this insurance company will go to the payer electronically. If not checked, claims will be printed on a CMS 1500 form.

Note: If a Payer/Insurance Company normally accepts only paper claims, but claims will be sent to GatewayEDI to drop to paper and forward to the Payer, see next step for setup information.

4. Electronic Submission Info is inserted into the Electronic Insurance files to identify Payer , Clearinghouse and Type of claim.

Note:  All fields are required when submitting electronic claims. Payer ID and Receiver ID.will be provided by your Clearinghouse.

Payer Qualifier-Identifies type of Payer ID. (For most Payers, this will be ZZ-Mutually Defined)

Payer ID-Identifies the Payer of claims submitted for this Insurance Company. (GatewayEDI will provide a list of your Payer IDs)

Note: All payers that will be sent electronically to GatewayEDI and then dropped to paper claim by Gateway, will be Payer ID 00010

Clearinghouse Name-Identifies the Clearinghouse. (GatewayEDI)

Clearinghouse ID-Identifies the Clearinghouse. (GatewayEDI  ID shown in example)

Type (If Primary) - Identifies the Type of claim/insurance company. For Primary, the most common types will be:

CI - commercial

BL - BCBS

MC - Medicaid

MB - Medicare

Type (If Secondary)-Identifies the Type of claim/insurance company. For Secondary, the most common types will be:

SP-Supplemental Policy

GP - Group Policy

MI - Medigap Part B

Receiver Qualifier-Identies the Receiver ID.  (For most Receivers, this will be ZZ-Mutually Defined)

Receiver ID-Identifies the Receiver of the Electronic file submitted. (GatewayEDI Receiver ID shown in example)

The information in Provider Setup section is required when filing claims, and is used to file to identify the Rendering Provider of Service, The Pay To Group/Provider and other identifiers.

5. Click the New Provider Mapping button (Green +) to add Providers of Service to this Insurance Company.

6.  Click to highlight a Provider and Click the Add button to open the Edit Billing Information dialog.

Edit Billing Information dialog is used to identify Billing/Pay To information (top portion) and Rendering Provider of service (bottom portion). This information will be included on all claims submitted to this Insurance Company.  

7. This section is populated with data used when setting up Manage Groups. Verify that this is the correct Pay To information. To edit information and Add a Submitter Id for Electronic claims, Click to place a check mark in the Override Group Values box.

8. If the Pay To provider is an individual and payments are reported to his Social Security number, Click SSN and type social security (Block 25)

9. Use drop down to select type of ID number to include in the file-Billing Legacy number, Billing Taxonomy code, etc. and enter the number in the next field. T

10. For Electronic claims, use the drop down arrow to select an identifier for the Submitter ID and then Type the ID into the ID field. This information is provided by your Clearinghouse or Receiver of electronic files. For paper claims, leave blank.

10. This section is populated with data used when setting up Provider Manager . If this insurance requires a Rendering Provider Legacy number  or a Rendering ProviderTaxonomy Code for the Rendering Provider, in addition to the NPI, use the drop down arrow to select an identifier for the ID and then type the ID into the field. (Block 24j)

11. Click the Save button. Save Mapping dialog asks if you would like to link this insurance company to the specified group, Click Yes.

Tools -> Insurance Companies

1. Click on the Insurance Company to be deleted.  

2. Click on the Remove Company Icon (Red X). You will be prompted to verify that you want to remove the selected insurance company.

3.  You will be prompted to verify that you want to remove the selected insurance company. Yes to delete, No to cancel

Note: Users must have security privileges to delete an Insurance company. Insurance demographics will have to be updated for any patients that  have the deleted insurance company in their information.