Insurance Company Master – Partner Academy

All About Insurance Company Master

This article explains the following:

A. Features in the Insurance Search Screen

B. How to add a new insurance company

C. How to Add and Edit Insurance Plans

D. How to edit insurance company information

E. How to merge two or more insurance company records into one.

Insurance Search Screen

Select Setup from the main menu and click on Insurance/Plan. A window to search insurance opens up where existing insurances can be searched.

Image 1

1. Select Setup from the main menu and click on Insurance/Plan to access the insurance search screen.

2. Search for an insurance using any of the filters provided, such as ins. name, payer ID, payer type, claim type, etc.

3. The Insurance search screen has a Merge icon (Highlighted in Image 1) to merge duplicate companies into one.

4. The search screen also has an icon to export the master records to an Excel file. The Excel file also provides information on the creation date of the insurance.

Add Insurance Company Information

There are two ways to add insurance company information.

1. Click on button. From the Search Claim Payers screen, select a Claims Receiver from the dropdown; Claim Receiver is a mandatory field. Click on search. This opens the repository of insurance companies; see Image 2. Select the checkbox corresponding to the insurance to be added to the practice. This way multiple insurances can be added to the practice in one go.

Note: When adding a new payer via Additional Payers from the clearinghouse, if the payer address is not found in the repository, the system will now assign a non-real address instead of the practice address. Users will need to update the correct address.

Image 2

2. The other way is to click on button. The Insurance Information screen opens up.

Image 3

Important fields in the Insurance Information Screen

Field	Description
Name	Insurance Company Name
Payer ID	Payer IDs are provided by the clearinghouse.
Payer Type	Select the appropriate type from the drop-down. The default value is Commercial Insurance Co. For Medicare, payer type is Medicare For Blue Cross Blue shield, this will be Blue Cross blue shield
End Date Effective	The end date is provided in case the insurance info is no longer to be used.
Contact Information	Enter Address, Zip Code, City, State, Country, etc.
Submission Method	This is the EDI setup information for the payer. Select Clearing House, Primary and Secondary Billing Method (EDI/Paper) for the insurance.
Additional Information	This includes Eligibility Payer ID, Claim Type, Response Limit Threshold, A/R Method, etc. A/R method
Eligibility payer ID	This is the third-party payer ID used for eligibility verification.
Sub payer ID
Other External payer ID(s)	This is used in interface accounts for mapping payer IDs received via interface to the selected payer.
Claim Response Limit	The no. of days a practice has to wait for the payer’s response after the claim is sent before it can move the claim to the No-response category.
Untimely Filing Limit	The maximum no. of days after the DOS for the practice to file the claim
Response Limit Threshold	The number of days after the DOS for the practice to file the claim and receive the payer response
Claim Type	Select either PROFESSIONAL/INSTITUTIONAL
A/R method	Select any one from drop-down: Attorney, Auto Claims, Calling, PS Claims, VOB, Web, and Workers Comp.
Exclude Prior PR. Payment
Capitated plan

Enter the necessary insurance details and click on Save.

* A Default plan is created automatically upon saving the new insurance.

Image 4

Add & Edit Insurance Plans

To add a new plan, click on button. Once the details are entered, click on button to save the plan; see Image 4a.

Image 4a

If the default plan needs to be edited, click on the icon.

Note: The plans should be linked with patient insurance while adding insurance to the patient demographic page.

Image 5

Edit Insurance Company Information

1. To search for an insurance company, type in the full/partial name and click on search. You can also search for an insurance company by the payer ID. A list of insurances matching the search criteria will be displayed; see Image 6.

Image 6

2. Check the box Include Inactive to include end-dated insurance in the search result.

3. Click on the button (highlighted in Image 6) to open the Insurance Information. Perform the necessary edits and click on .

Merge Insurance Companies

Two or more insurance Companies can be merged into one master insurance. Click on the merge icon in the insurance company search screen.

Image 7

1. A screen, as in Image 7, opens up. Check the box under Master Column for the single insurance, which is the master insurance under which all others will be merged.

2. Check the boxes under Duplicate column for all insurances to be merged to the master.

3. Click on button.

4. On successful merge, all duplicate insurances will be end-dated.