The first step in creating a claim is creating the insurer. To do this, ensure you are logged into an account with at least Administrative Staff/All Billing Access permissions.
*Please note, this is for accounts subscribed to the Insurance Plan.
Create an Insurer
In Settings on the left hand side, scroll down to the Billing section - Insurers
Select New Insurer from the top right:
The next step is to select the Insurer Type:
Important: You’ll need to select the Health Insurance option if you need to generate CMS-1500/HCFA forms or EDI files to submit for clients covered by the insurer you’re creating.
After selecting the Insurer Type, you’ll need to enter in the insurer name (required) and contact information (optional).
Currently, Health Insurers (whose claims are to be submitted to a clearinghouse via an EDI file) require a Payer ID and/or the full address information.
To sum it up for you, here is a list of the required fields for Health Insurers if you’d like to use our EDI generation tool for submission:
- Insurer Name
- Payer ID and/or Full Insurer Address
- Insurance Program
You may also enter a portal is appropriate. This could be a clearinghouse billing portal such as Office Ally, Trizetta, and/or Availity. This will allow you to launch the portal directly for claim submissions.
You can view some more information about managing claims and portals on this guide: Generating an EDI to Submit to a Clearinghouse.
Determine Patient’s Fee
When setting up your insurers, you’ll need to select the fields that you’d like to display when billing your insurance patient’s for this insurer.
The list of options includes:
Patient Pays Remaining (If you’d like Jane to by default pass what isn’t covered by insurance on to your patient)
Co-Pay ($ amount)
Deductible ($ amount)
Coinsurance ($ amount)
Percentage Coverage (% amount)
The actual amount you bill to each of your patients will be based on the coverage set on the claim you’ll create for each patient following this guide: Creating a Patient Claim (US)
You may also notice there is a Billing Codes First field when setting up your Health Insurance Insurers.
For more information on what this can be used for, please have a look at the following guide: Billing Codes First vs. Insurer Specific Codes
If you have any questions along the way, please email us at firstname.lastname@example.org to discuss your options.