Setup Insurance Companies

Q: How do I setup insurance companies?

*Note: PM Setup

The Practice Management setup process must be completed in a specific order.  Please follow the setup lessons for step-by-step instructions.

1. Open the Insurance Company Manager

1. Open the Insurance Company Manager

Click on the Tools menu, then select Insurance Companies.

2. Add a New Insurance Company

2. Add a New Insurance Company

Click the Add New Company (Green +) button.

3. Complete Insurance Company Information

3. Complete Insurance Company Information
  • Company Name, Address, City, State, Zip, Phone, Fax: Enter the insurance companies demographic information.
  • NPI: Not yet implemented, leave blank.  In the future, this spot will hold the National Plan Identifier/Pay-To Plan secondary identification.
  • Type (CMS 1500): Box 1 on CMS 1500 form; select the insurance company type.
  • Eligibility ID Qualifier: This will identify the type of Receiver ID used for checking insurance eligibility for patients. Add Eligibility ID in each provider's billing information (See Step 6) For payers requiring a Legacy ID , select ‘Prior Identifier Number - Q4’ For payers requiring a Tax ID , select ‘Federal Taxpayer Identification Number-TJ’.  If the tax ID option is selected, the Receiver ID field is automatically populated from the Group/Billing tax ID setup in Manage Groups. There are several other options in the drop down but they’re currently not used. If not required by the payer, leave blank.
  • 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 (Lefacy): This can be used for information purposes, to display any Legacy Fee Schedules previously assigned to this Payer.
  • Fee Schedule: Using the drop-down menu, select the appropriate fee schedule.

4. Complete Electronic Submission Info

4. Complete Electronic Submission Info
  • Payer Qualifier: Identifies the type of Payer ID (for most payers, this will be Mutually Defined - ZZ)
  • Payer ID: Identifies the payer of claims submitted for this insurance company (Gateway EDI will provide a list of Payer IDs).  Note: All payers that will be sent electronically to Gateway EDI and then dropped to paper claim by Gateway, will be Payer ID 00010.
  • Clearinghouse Name, ID: This information will be pre-populated from the Claims Options section
  • Type: Identifies the type of claim for the insurance company
  • Receiver Qualifier, ID: This information will be pre-populated from the Claims Options section

5. Complete Additional IDs

5. Complete Additional IDs
  • EIN: enter the payer EIN
  • Claim Office#: enter the payer claim office number
  • NAIC Code: enter the payer National Association of Insurance Commissioners code
  • Active: indicates that the insurance company is active.  This box will be checked by default.  Un check the box if you wish to inactivate the insurance company.
  • Show Legacy IDs: If checked, the Legacy numbers entered for the company will be included on all claims.
  • Default Electronic: If checked, the claims for this insurance company will be sent electronically by default.  If not checked, the claims will be printed by default on a CMS 1500 form.

6. Setup Rendering Providers

6. Setup Rendering Providers

The Provider Setup section is sued to identify the rendering provider of service, the pay-to group/provider and other identifiers.  This information is required when filing claims.

To setup a rendering provider:

  1. Click the Green +
  2. Select the provider that will be added to the insurance company using the drop-down menu
  3. Click the Add button

7.  Edit Billing/Pay-To Information for Payer

7.  Edit Billing/Pay-To Information for Payer

Insurance Payment To: This section is populated with data used when setting up Manage Groups.

  1. Demographic Info: Verify that this is the correct Pay To information. To edit information or add additional IDs required for this payer, click to place a check mark in the Override Group Values box.
  2. Tax ID: If the pay-to provider is an individual and payments are reported to the Social Security Number, select SSN and type in the number (block 25).
  3. Paper - Legacy ID: When filing paper claims, if the payer requires a billing legacy number in addition to the billing NPI, select legacy qualifier from the drop down list and enter the legacy ID.
  4. Electronic: Add any additional ID number, if they are required for the selected payer.
  5. Pay-To Address: If the pay-to address is different than the billing provider street address, enter that information here.
  6. Eligibility Request Info: Some payers require a Tax ID or a legacy ID to be sent with an eligibility request. If a payer does not require one, this section can be left blank. Below is a list of some that do require this information:

Payers requiring Legacy ID

  •    BCBS of Arkansas
  •    BCBS Michigan
  •    California Medicaid
  •    Maine Medicaid
  •    Mercy Health Plan of Arizona
  •    Ohio Medicaid
  •    University Family Care of Maricopa
  •    Wisconsin Medicaid Well Woman Program

Payers requiring Tax ID

  •    AFTRA
  •    American Postal Workers Union
  •    American Republic Insurance
  •    Amerigroup, Carefirst BCBS
  •    Cariten Healthcare
  •    Cariten Senior Healthcare
  •    Fallon Health Plan
  •    Keystone Mercy Health
  •    Kaiser Foundation Health Plan of Northwest
  •    Lovelace Health Plan
  •    Mayo Management Services
  •    Mega Life
  •    Midwest National Life
  •    Physicians Mutual Insurance
  •    Preferred Health Systems
  •    Significa Benefit Services
  •    Texas CHIP
  •    Trustmark Insurance
  •    Writers Guild
  1. Legacy ID: If this insurance requires a Rendering Provider Legacy number 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)
  2. Electronic: Enter any additional IDs to be included on electronic claims, if required by this payer for Rendering Provider.
  3. Click Save for finish.

8.  Link Insurance Company to Group

8.  Link Insurance Company to Group

After clicking Save, the above pop-up will appear.  Click Yes to confirm that you would like to link the insurance company to the specified group.  Click No if you do not wish to link the insurance company to the specified group.

9. Save the Insurance Company

9. Save the Insurance Company

Repeat steps 6-8 to add all rendering providers to the insurance company.  When finished, click OK to save the insurance company.

10. Repeat Steps 1-9

Repeat the above steps to add all insurance companies.