Claim settings are used to format electronic claim submissions and paper claim printing. Claim settings are made for each provider and can be general (affecting all payers) or more specific (overrides for a specific payer). Note that if a provider has a pay-to address that is a PO Box or Lockbox, this option must be selected; this setting can be made for either all payers or specific payers; see below.
To set up provider claim settings
- Click Settings > Providers.
- Once you find the provider, double-click to open the record.
- Click the Claim Settings tab. Select your settings. See below.
- Click Save or the Provider Performance Report tab to select report settings.
- NPI: Select one of the following in the drop-down menu:
- Bill with Group and Individual NPI: Select if the provider is credentialed with payers to send claims with both a Group and Individual National Provider Identifier (NPI). Enter the Individual NPI and the Group NPI in the fields provided.
- Bill with Individual NPI Only: Select if the provider is credentialed with payers to send claims with only an Individual NPI. Enter the Individual NPI in the field provided.
- Override Group NPI?: If "Bill with Group and Individual NPI" was selected for the NPI field, check this box if you need to send claims for this provider with a different Group NPI than was entered for the practice. Enter the alternate Group NPI in the Override Group NPI field.
- Tax ID: Select one of the following in the drop-down menu:
- Bill with EIN: Select if the provider is credentialed with payers to send claims using an Employer Identification Number (EIN) assigned by the IRS to the practice. This applies to any business entity including a Corporation, LLC, LLP, Partnership, or other taxable business entity. Enter the EIN in the field provided.
- Bill with SSN: Select if the provider is credentialed with payers to send claims using the provider's Social Security Number (SSN). This might be the case if your practice is a sole proprietorship and has not been assigned an EIN from the IRS. Enter the SSN in the field provided.
- Override EIN?: If "Bill with EIN" was selected in the Tax ID field, check this box if you need to send claims for this provider with a different EIN than what was entered for the practice. Enter the alternate EIN in the Override EIN field.
- Enable Pay-To Address: If the pay-to address is a PO Box or Lockbox, check this box and enter the name and address in the fields provided. Checking this box enables the pay-to address you enter for all payers. To add a pay-to address for specific payers only, see next section.
- Override Claim Settings: Add, edit or remove any insurance companies or service locations that have exceptions to your general claim settings. You can set overrides to practice settings, paper and electronic claim settings, submitter number, etc. Click Add on the right to set overrides. On the Override Claim Settings window, check the "Show advanced settings" box to see more settings.
To add a pay-to address for a specific payer
- On the Claims Settings tab, click Add on the right. The Override Claim Settings window opens.
- Click the Insurance Company button. The list of insurance companies opens.
- Double-click on a payer to which you want to apply the pay-to address override.
- To ensure that your NPI is submitted correctly to your specific payer, confirm that the NPI scenario selected matches your scenario for the payer.
- Check the “Show advanced settings” box.
- Check the “Override pay-to address” box.
- Enter the address to where payments are to be sent.
- In the Pay-to Name field, enter the name for the pay-to address if desired.
- Click Save in the Override Claims Settings window.
- Click Save in the Edit Provider window.