Add Insurance from the RXNT Master List. 

The Insurance Companies section is for the payer set-up or the entity, other than the patient, responsible for financing or reimbursement for the cost of the services rendered.

Payers must be set up so that claims can be sent and payment can be rendered. To set up a Payer, click Utilities in the top right corner.

Click Practice Setup then Insurance Companies. By clicking New Payer, you can designate the payer or individual/entity accountable for settling the claim's payment.

 Select a payer from the Master Payer List, which contains information for over 3,000 payers.

New Payer Setup

• Select the payer’s name
• Payer Electronic ID automatically populate
• Primary payer's claims will remain electronic, while claims from smaller companies and Worker’s Comp will be printed
• The secondary claim is typically printed for a hard copy of the HCFA1500
• The claims indicator is Commercial unless Medicare, Veterans, and other exclusions
• apply
• The type of insurance must be from the drop-down menu
• The default fee schedule is what the practice has set up for the payer
• Claims-specific rules that apply to the payer when creating the EDI or the HCFA1500 form can be added.
• Currently, there are six rules listed, but if more are identified, they can be added in less than a week. Please contact RxNT support at 800-943-7968 to request a rule to be added.

Add Custom Payer

By clicking New Payer, you can designate the payer or individual/entity accountable for settling the claim's payment.

Next, select the Custom Payer checkbox and complete the necessary fields. 

Create and Link Financial Class to Payers

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 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. 

Note: You can link only one Financial Class at a time to a payer.

Next, in the Payer screen select the Financial Class from the drop-down.

Set Claim Specific Rules- CMS 1500 Form

Under Practice Setup and Insurance Companies. 

The image below is from inside a payer profile. Navigate down to the Claim Specific Rule and select the green +.  

To learn more about Claim Specific Rules, click here!

Display CLIA on Box 19

Practice Setup and Insurance Companies. 

In the drop-down, select display CLIA on Box 19 and save. 

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

Add the CLIA # and click Save.

Next, navigate to the Procedure Codes section and click on the designated procedure code.

Click the CLIA Lab Procedure checkbox.

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, the fee schedule will automatically be set as the default within an encounter whenever that particular payer is added to a patient's case and an encounter is created. Additionally, when CPT codes are added, the associated fee amounts will automatically populate, streamlining the process of creating encounters and ensuring accurate billing. 

Choose the Default Fee Schedule from the dropdown list. 

Click Save.

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