Adding Billing Configurations

ADDING A BILLING CONFIGURATION

Billing Configurations must be set up so that the system knows how each provider bills for and was credentialed with respective payers. Is the provider credentialed with their SSN or Tax ID? What fee schedule should the system automatically pull when an encounter comes through with this payer? These are the questions Billing Configurations aim to address.

Each provider should have at least one Default billing configuration (for all payers without their own specific configuration) and one Self Pay configuration (for patients who do not have insurance but have a medical procedure/CPT performed). Additional Specific configurations should be added for individual payers if the provider is credentialed differently with those payers or if the office wants to bill differently than the Default for those payers. If Billing Configurations are not properly set up based on how the provider is credentialed, you will receive rejections.

 

Billing Configurations can be accessed via the provider's login or by any user in the system who has the role of Biller and has the Biller Admin privilege toggled on in their account. 

 

1. First, make sure you have entered Fee Schedules for your Billed amounts into the system under Practice > Practice Fee Schedules.

2. Log into the Practice Management System using the provider's login information. Billing Configurations must be set up within each individual provider's account because providers may bill differently from one another depending on how they were credentialed.

3. Once logged in, click the practice name in the upper left-hand corner and go to Billing Configurations.

4. Click "Add New Configuration.”

5. Fill in the appropriate information based on an explanation of the settings below and click “Save.”

Note: Existing claims will not automatically pull a new configuration or new settings, but any claims moving forward will. If you have existing claims that you need to pull the latest Billing Configuration settings for, open the claim and reselect the appropriate Billing Provider from the Billing Provider dropdown.

 

 

BILLING TYPE

Default - Check “Default” if this configuration should be used for all payers which do not have their own Specific configuration.

Self Pay - Check “Self Pay” if this configuration should be used when the Self Pay insurance profile is selected in a claim (patient does not have insurance).

Specific - Check “Specific” if this configuration should be used only for a specific payer and select that specific payer from the “Insurance Company” field.

 

DETAILS

Insurance Company - When setting up a Specific configuration, use this field to select which insurance company the configuration is for. It is important to be specific when picking from the Public and Private lists. If a payer is selected from the Private list when setting up a Billing Configuration but the patient’s Insurance Profile is created using a payer from the Public list, then the Billing Configuration will not affect that patient’s claims. The payer selected within Billing Configurations and the payer selected in the patient’s Insurance Profile must match in order for the configuration to affect that patient’s claims.

Effective From - Set a start date for this configuration. Claims before this date will not be affected by the configuration.

Effective To - Set an end date for the configuration (optional). Claims after this date will not be affected by the configuration.

Bill As (Box 25 - Federal Tax ID Number/L2010AA)

• Set the “Bill As” field to Practice if the practice’s federal Tax ID should print in field 25 of the CMS 1500 form and the EIN box should be checked (corresponds to L2010AA on electronic claims).
• Set the "Bill As" field to Provider if the Billing Provider’s Social Security Number from their Account settings should be printed in field 25 of the CMS 1500 form and the “SSN” box should be checked (corresponds to L2010AA on electronic claims.

Pay As (Box 33, 33a - Billing Provider Info and NPI/L2010AB)

• Set the "Pay As" field to Practice if the practice name and address from the Practice settings should print in field 33 and field 33a should contain the Practice (Group) NPI from the Practice settings (corresponds to L2010AB on electronic claims, which will only be populated if “Use Practice as Pay To” and “Use Practice as Bill To” have different values).
• Set the "Pay As" field to Provider if the Billing Provider’s name and address from their Account settings should print in field 33 of the CMS 1500 form and field 33a should contain their individual NPI (corresponds to L2010AB on electronic claims, which will only be populated if “Use Practice as Pay To” and “Use Practice as Bill To” have different values).

SEND ELIGIBILITY REQUEST AS

• Select Practice if eligibility requests for the specific payer should be sent under the Practice (Group) NPI.
• Select Provider if eligibility requests for the specific payer should be sent under the individual provider’s NPI. When checking eligibility from the Schedule, this means the Attending Provider’s individual NPI (Account settings). When checking eligibility from the Insurance Profile, this means the practice’s Default Provider (Practice Settings > General Info).
• Note: When checking eligibility from the patient’s Insurance Profile, the system will use the practice’s default provider’s Billing Configurations for that specific payer. If no Billing Configuration is set for that specific payer, the system will use the settings of the Default configuration.
• Note: This field does not affect claims at all. Only which NPI eligibility requests are sent under.

ACCEPT ASSIGNMENT (27 - Accept Assignment)

• Check “Accept Assignment” if “Yes” should be checked in field 27 of the CMS 1500 form.
• Uncheck “Accept Assignment” if “No” should be checked in field 27 of the CMS 1500 form.

 

 

FEE SCHEDULE LIST

• Click “Add Fee Schedule” to select the fee schedule to be used as your Billed amounts for one or multiple Clinic locations. If no fee schedule is selected, $0 will pull as the Billed amount when the provider signs off on the Progress Notes and Encounters come through to be posted.

 

 

ADVANCED SETTINGS

Advanced Settings allow you to override certain fields of your office’s paper and electronic claims. Advanced Settings are not available for the “Self Pay” configuration.

Applied for Clinics - select one or more clinic locations for which these advanced settings should apply.

 

 

Basic

NPI - 33a (L2010AA, NM1-09)

Override Federal Tax ID or SSN - 25 (L2010AA, REF(1))

Billing Provider Qualifier - 33b (L2010AA, REF(2))

• 0B - State License Number (paper and electronic claims)
• G2 - Provider Commercial Number (paper and electronic claims)
• ZZ - Provider Taxonomy (paper and electronic claims)

Attending Provider Qualifier - 24i, 24j (L2310B, REF)

• 0B - State License Number (paper and electronic claims)
• 1G - Provider UPIN Number (paper and electronic claims)
• G2 - Provider Commercial Number (paper and electronic claims)
• LU - Location Number (paper and electronic claims)
• ZZ - Provider Taxonomy (paper and electronic claims)

Referring Provider Qualifier - 17a (L2310A, REF)

• 0B - State License Number (paper and electronic claims)
• 1G - Provider UPIN Number (paper and electronic claims)
• G2 - Provider Commercial Number (paper and electronic claims)
• LU - Location Number (paper and electronic claims)

 

 

Bill To Info

Bill To Name - Will not affect paper claims (L2010AA, NM1)

Street Line 1 - Will not affect paper claims (L2010AB, N3, N4)

 

 

Pay To Info

Pay To Name - 33b (L2010AB, NM1)

Street Line 1 - 33b (L2010AB, N3, N4)

Note: When an encounter is signed off, a new billing encounter created manually, and a claim generated, the Billing and Rendering Provider information from the Advanced Settings with automatically populate in the Additional Information section. If a value is changed in the Advanced Settings, already saved claims will not be updated automatically without reselecting the Billing Provider from the dropdown.