Create a financial class 

Financial classes bring the ability to group different payers into a similar category for billing and reporting purposes. Payers' financial class options are selected on the Payer screen once they've been created.

Click Utilities. 

Click Practice Setup then Financial Class.

Click New Financial Class.

Give your financial class a Class Name, and select a Class Member from the dropdown menu. 

Click Save. 

Link a financial class

Navigate to the Insurance Companies screen, and click on the payer's name.

From the Payer screen, choose the Financial Class from the drop-down menu and click Save. 

Set claim specific rules

Claim specific rules are used when a payer requests certain information to be included in a particular section of the claim form. These rules need to be set up for each insurance company that you want to change what is displayed on the CMS 1500 claim form. When adding or editing a payer, claim specific rules can be created at the bottom of the screen. Click here to learn more!

For instance, if the payer requests that the CLIA number be displayed in Box 19 on the 1500 claim from, follow these steps:

Click the Green(+) and select Display CLIA on Box 19, then click Save.

Next, go to Service Facility Locations and click on the location Name. 

Enter the CLIA number in the CLIA field and click Save.

Then, navigate to the Procedure Codes and choose the appropriate procedure code.

In the Charge Transaction Code screen, click the CLIA Lab Procedure box, then click Save.

Once you've finished the outlined steps, ensure that on your encounter screen, you select a payer with the claim-specific rule you established, a service facility location with the CLIA number, and include a CLIA Lab Procedure code. This ensures that the necessary information is populated on your claims form in Box 19.

Link default fee schedule

When you link a default fee schedule based on payer-specific charge amounts, it will automatically set as the default in an encounter whenver the payer if added to a patient's case. Additonally, when CPT codes as entered, the corresponding fee amounts will auto-populate, sinplifing the encounter creation process and ensuring accurate billing.

Select the Default Fee Schedule from the dropdown list, then click Save.

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