Linking a financial class, setting claim-specific rules, and associating fee schedules in the Payer screen is essential for accurate and efficient billing. By linking a financial class and fee schedule, claims are automatically billed according to the payer’s requirements, helping to reduce errors and denials while speeding up reimbursements. Claim-specific rules are used when a payer requires certain information to appear in a specific section of the claim form. These rules must be configured for each insurance company where you want to customize how information is displayed on the CMS 1500 claim form.
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, select the financial class from the Financial Class dropdown menu, then click Save.
Link default fee schedule
Linking a default fee schedule based on payer-specific charge amounts ensures it is automatically applied to an encounter whenever that payer is added to a patient’s case.
On the Payer screen, select the fee schedule from the Default Fee Schedule dropdown menu, then 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 example, if a payer requires the CLIA number to appear in Box 19 on the 1500 claim form, follow these steps:
Click the green (+) button, select (Box 19) Display CLIA on Box 19, and then click Save.
Next, go to Service Facility Locations and click the location Name.
Enter the CLIA number in the CLIA field and click Save.
Next, go to Procedure Codes and choose the appropriate procedure code.
In the Charge Transaction Code screen, check the CLIA Lab Procedure checkbox and click Save.
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