Insurance

This page will assist you with managing and creating insurance company records in TRAKnet 3.0.

Insurances

The insurance category of the Properties tab is where insurance companies for billing purposes will be entered. Insurance companies must be entered before insurances can be set on the patient's chart, billed to, or payments can be downloaded.

Insurance information will be provided by your clearing house and can be found on the Trizetto Provider Solutions website under the payer list.

Adding Insurance Records

To add insurance companies to your database, you will use the Insurance menu. You can add a new insurance by clicking the green “Add” button in the upper left-hand portion of the screen from the Insurance category of the properties tab. Newly created insurances will automatically be set to receive ICD-10 codes as the preferred coding format.

Insurance companies have a a wide variety of information and settings available on each record.

Insurance Company Editor Window

The insurance company editor window is broken down into several tabs along the top of the screen. These tabs are:

General

insgeneral.JPG

This tab contains general identification information for this insurance company.

  • Name — The name of the insurance company.
  • Address Line 1, Address Line 2 — Address information for the insurance company.
  • City, Stage, Zip Code — Address information for the insurance company.
  • Phone (Primary) — Primary contact number for this insurance company.
  • Phone (Secondary) — Secondary contact number for this insurance company.
  • E-Mail — Primary email contact for that insurance company.
  • Website — The insurance companies website.
  • Contacts — List of contacts at that insurance company.
  • Payer ID — The identification number for the insurance company. Can be found on the payer list. This is the number TRAKnet will use for insurance identification.
  • Claim Office Number — Claim office identification number.

Claim Details

insclaimdetails.JPG

The claim details tab of the Modify Insurance window contains various insurance specific settings for billing purposes. These settings will determine how the claim will send to fit a specific insurance's preferences. The settings are detailed below.

Claim Information

  • Claim Output — The typical method of claims submission (Electronic/ANSI, CMS/Paper) to this insurance company.
  • Insurance Type Code — Two character identifier used in claims processing to identify the type of insurance, e.g. CI - Commercial Insurance, MB - Medicare Part B.
  • Practice Legacy Number — A specific identifier that may have been assigned by this insurance company for this practice. These numbers are not required in all situations as they have been slowly phased out and replaced by NPI.
  • Has Assignment — A true or false setting. Can this insurance company assign benefits to the practice on behalf of the patient? If true, then the practice is authorized to receive payments directly on submitted charges. If false, patients will receive insurance payments.
  • Request Eligibility — A true or false setting. Can eligibility requests be sent? If True, then eligibility requests can be submitted to this insurance company. Some insurances require enrollment and charge per request.
  • Minnesota Care Tax Eligible — A true or false setting. Is the practice response to Minnesota Care Tax when accepting payments from this insurance? If true, then the practice will need to account for this tax on any payment received from this insurance.
  • Set Supervisor on Claims — A dropdown menu that will determine who is the supervisor on a claim. Can be either Rendering Provider, Primary Care Physician, or Referring Provider.

Eligibility

  • NPI — The NPI submitted on eligibility requests. A free text field.
  • Practice or Provider Last Name — The practice name or provider's last name submitted on insurance requests. A free text field.
  • Provider First Name — The provider's first name submitted on insurance eligibility requests. Please leave blank if the practice name is submitted. A free text field.
  • Provider ID — The provider's ID, if required, to be submitted with insurance eligibility requests.
  • Federal Tax ID — The practice's or provider's federal tax ID, if required, to be submitted with insurance eligibility requests.

ANSI 837

ANSI 837 is the electronic claim submission format.

  • Send Patient Payment Amount — A true or false setting. If true, then the sum of patient payments, if any, will be sent. If false, then no patient payment amounts will be sent.
  • Send Rendering Provider — A true or false setting. If true, then the rendering provider loop will be sent, when available.
  • Send Ordering Provider Address — A true or false setting. If true, then the ordering provider's address will be sent, when available.
  • Sent Treatment Description — A true or false setting. If true, then treatment description will be sent as part of the claim treatment details, when available.

ANSI 837 and CMS 1500

  • Send Facility NPI as Billing NPI — A true or false setting. If true, then the facility/location NPI will be sent as the billing NPI in box 33.
  • Send SSN — A true or false setting. Send social security numbers (SSN) for patients, subscribers and providers. If true, then SSNs will be sent, when available.
  • Send Legacy Numbers — A true or false setting. Send legacy numbers for facilities and providers when submitting claims? If true, then legacy numbers, when available, will be submitted on claims.
  • Send NPI and Date Last Seen — A true or false setting. Send NPI and date last seen on claims? If true, then this information will sent via ANSI in Loop 2300 NTE section and via CMS in box 19.
  • NPI to Send with Date Last Seen — This setting determines which NPI number should be sent with the date last seen. Accompanies above setting. Can be: Referring NPI or Supervising NPI.

CMS 1500

  • Print Address — A true or false setting. If true, then insurance address will print in the upper right-hand corner of the CMS. If false, then the upper right-hand corner will be blank.
  • Set Box 9a from Box 1a — A true or false setting. If true, then Box 9a will always use the information as entered in Box 1a. If false, then Box 9a will use the information as it pertains to the other insurance.
  • Box 17a Identifier — A setting to determine which referring provider identification number will be printed on the CMS claim, when available. Can be: UPIN, Legacy Number, SSN, Taxonomy Code or none.
  • Use box 17a Qualifier — A true or false setting. If true, then the CMS two character qualifier for the respective identifier (UPIN, legacy number, SSN, Taxonomy Code) will print.
  • Send NDC in Box 24f — A true or false setting. If true and the treatment has an associated NDC, it will print in box 24f above the charge amount.
  • Box 24j Identifier — Selection of which referring provider identification number (UPIN, Legacy Number, SSN, Taxonomy Code or None) will be printed on CMS claims, when available. A drop down selection of: none, Legacy Number, SSN, Taxonomy Code or UPIN.
  • Box 24j Qualifier — A true or false setting. If true, then the CMS two character qualifier for the respective identifier (UPIN, Legacy Number, SSN, Taxonomy Code) will print.
  • Box 29 Amount (Primary) — The amount to be calculated in Box 29 based upon a primary claim submission. If none, then the field will be blank. If all, then adjustments/WO will be included in the calculation.
  • Box 29 Amount (Other) — The amount to be calculated for Box 29 based upon a secondary, tertiary or other claim submission. If none, then the field will be blank. If all, the adjustments/WO will be included in the calculation.
  • Box 30 Amount (Primary) — The amount to be displayed for Box 30 based upon a primary claim submission. If none, then the field will be blank. This is no longer a required box on the CMS 02/12 claim form.
  • Box 30 Amount (Other) — The amount to be displayed for Box 30 upon a secondary, tertiary or other claim submission. If none, then the field will be blank.
  • Use Box 32 — A true or false setting. Print location, NPI, and legacy numbers in Box 32 on the CMS 1500 form when the place of service is 12 (patient's home)? If false, then the service facility location, NPI and legacy number will not print when the place of service is 12.
  • Box 33b Identifier — Selection of which billing provider identification number (UPIN, Legacy Number, SSN, Taxonomy Code, or none) will be printed on CMS claims, when available.
  • Use Box 33b Qualifier — A true or false setting. If true, then the CMS two character qualifier for the respective identifier (UPIN, Legacy Number, SSN, Taxonomy Code) will print.

Surgery Center

  • Drop Leading Zeroes on Codes (Boxes 4 and 42) — A true or false setting. Drop leading zeroes off Type of Bill (Box 4) and Revenue Codes (Box 42)
  • Patient Identifier Number (Box 8a) — Patient identifier (Box 8a) as either the subscriber ID (Box 60), account number (Box 3a) or none.
  • Set Admission Date (Box 12) from Note Date — A true or false setting. Set admission date (box 12) from Note Date.
  • Responsible Party Entity (Box 38) — A setting to determine who the responsible party is. It can be either legal representative/patient or insurance company (Box 38).
  • Other Provider ID (Box 57) — The other provider ID (Box 57). A free type field.
  • Set Admit Dx (Box 69) from Principal Dx (Box 67) — A true or false setting. Set Admit Diagnosis (Box 69) as the same as Principal Diagnosis (Box 67).
    insclaimoff.JPG
  • Set Referring Provider to Other Provider (Box 78 or Box 79) — Sets the referring provider to either Box 78 or Box 79.

Claim Offices

Claim offices are insurance companies that are the same Payer ID as the "parent" or main insurance but have a different address. Claim offices are key to keeping billing in TRAKnet organized. The rule of thumb is as follows:

  • Does the new Insurance company have the same payer ID as an existing Insurance company?
  • If yes, then create as a claim office of the existing Insurance company. Modify the existing insurance, click on Claim Offices, and click Add.
  • If no, then create as its own insurance company.

If the insurance company that should become a claim office is already an existing insurance company, modify the existing insurance, and click Convert to Claim Office. Select the insurance company it is going to become a claim office of, and confirm. This is permanent.

Legacy Numbers

A location to set additional legacy numbers as required on a per insurance basis.

inslegnumb.JPG

Comments

A free type area where additional comments about the insurance company can be recorded.

Finalizing an Insurance Company

Once you have finished adding information to the Insurance editor window, click “Save” in the upper-right hand corner of this screen.

Additional Materials

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License