Loading...

Claims Sub-Tab

Field	Description
Process as Claim Type	Enter the type of claim to process for this payer. When you make a selection, the system populates the Billing tab with the Qualifier as Employers ID Number (EI) and the Data Element as Tax ID. Both 4010 and 5010 claim formats require the EI and Tax ID to be populated for the Billing Loop. The secondary reference qualifiers can be manually set or they may be set using a claims utility if additional qualifiers and data elements are needed. Note: If you select Blue Cross/Blue Shield (BL), then the Plan Code field changes to BCBS Plan Code. If you select one of these claim types (Blue Cross/Blue Shield, Champus, Commercial, Medicaid, Medicare, or Worker's Compensation), then default values for the claim type are automatically filled in for the Provider Secondary References section. If there are existing secondary references, they are replaced with new ones.
Financial Class	Enter the financial class associated with this payer.
Insurance Type Code	Enter the insurance type associated with this payer. If you select a MediGap policy, then the MediGap ID number field will display.
Medigap ID #	Enter the identification number associated with Medigap. This field displays if you selected Medigap as the Insurance Type Code.
Plan Code	Enter the payer's plan number that you want to add to the claim. This plan code (payer secondary qualifier) displays in the 2010BB - REF segment when the submitter profile option is activated. Note: A change to this Plan Code field does not automatically change the plan code on existing records in that use the payer. The plan code must be manually changed for the patient on the Insurance Maintenance window. Plan codes added or changed on the Insurance Maintenance window overrides the plan code selected here.
Force Medicare Part A on Inst Claims	Select this option to set Medicare Part A as the Claim Type for the payer. This option displays only when the Medicare Part B (MB) option is selected in the Process as Claim Type field.
Messa	Select this box for the appropriate plan type. When 1500 claims are generated for Michigan Blue Cross Messa Plan or Michigan Blue Shield Messa Plan claim types, the following information populates to the claim: Box 12 populates with “SIGNATURE ON FILE” and the date in the format MM/DD/YY. Box 13 populates with “SIGNATURE ON FILE”. Box 24G populates with the quantity of the line item. Note: The Messa check box only displays when Blue Cross/Blue Shield (BL) is selected in the Process as Claim Type field.
(Various insurance type-specific options)	Select the check box for the specific claim type associated with the payer. Different options display depending on your selections in the fields above.
Release of Information	Select to set the default for the release of information when a payer is attached to an encounter. The default is stored in the insurance record and displays on the Patient Insurance - Encounter window. Note: Use this setting for payers that require a different release of information value from the rest of the payers. This setting overrides the default Release of Information setting in the Chart practice preferences .
TPL Code	Enter the Third Party Liability (TPL) carrier code to use in Box 9a for secondary Medicare claims. The default code is used in the Insurance Maintenance window. If you want users to be able to change this code on the Insurance Maintenance window, disable the Prevent modifying plan name check box on the Defaults -2 tab .

Provider Secondary References: 1500, UB, and ADA Claims Tabs

Claims Sub-Tab