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Edit Insurances

If you need to edit an insurance after your initial account setup (completed from the Incomplete Constants report), use the following steps.

  1. Navigate to Admin and select Insurances.
  2. Click Search to display all company insurances or use the filters to narrow your results. The list of insurances is automatically sorted in alphabetical order by Insurance Name.
  3. Double-click on the Insurance you would like to make changes to and make updates as needed using the field definitions below.
    1. Address: Start by checking the address to confirm it’s a valid claims mailing address. This is crucial for claims that you need to mail. If you need to make changes, do so in the WebPT EMR.
    2. Balance Type: This field should always be set to Insurance, except if the insurance is Workers Comp (set to Workers Compensation) or if this is a Self-Pay insurance (set to Patient). Insurances with a Balance Type of Insurance or Patient will send patient statements, while Workers Comp will not send a statement. 
    3. Insurance Class: Click on the magnifying glass and search for the Insurance Class. Click Search to display all results. This is important as each financial class has specific claim formatting rules automatically applied to ensure proper billing. You can find a list of Insurance Classes here
      1. For Private Insurance, use PW if you cannot find the specific commercial payer.
      2. For Medicare Advantage plans, you must select Medicare Advantage as the Insurance Class. 
      3. For Medicare Supplemental plans, DO NOT select Medicare Advantage as the Insurance Class. 
    4. Insurance Type ID: This field adds additional formatting rules to your claims. Selections include Medicare, PTPN, Self Pay, and Other. 
    5. Tax Identification Number: This field has been added for a future product enhancement.
    6. Taxonomy Code: This field has been added for a future product enhancement. 
    7. Type of Bill: This field has been added for a future product enhancement.
    8. Payer Description: Enter the Payer ID, Payer name, or Outbound Payer ID in the Payer Description field. Select the correct payer from the drop-down. Use the magnifying glass if your initial search does not return any results. Note: When completing your EDI enrollments in Change Healthcare, you’ll be able to locate the Payer ID. This does not include Medicare. If you have trouble locating the correct payer description, we recommend logging into Change Healthcare and viewing those enrollments.
      1. If claims should be submitted on paper and do not require attachments, search for CMS15.
      2. If claims should be submitted on paper and do require attachments, search for Attach. Auto and Workers Comp payers must be set up as Attach (they cannot go electronically).
    9. Contact Name: Enter a contact name for the payer (optional).
    10. Contact Email: Enter a contact email (optional).
    11. Phone Customer Service: If you need to update this number, do so in the WebPT EMR.
  4. Enter any additional information and settings as needed.
    1. Phone Claim Status: Add the phone number to check on claim status here.
    2. Fax: The insurance’s claim department fax number.
    3. Weblink/User ID/Password: Informational field, not required.
    4. DDE/User ID/Password: Informational field, not required.
    5. Note: Information field, use as needed.
    6. SEC Routing: Enter a Secondary Routing ID number into this field to ensure the required code appears on the secondary claim. Important: Claims will appear on the Failed Charges report if the SEC Routing field is blank and the secondary payer is Medicaid.
    7. ICD Codes for Billing: Select from using ICD-9 or ICD-10 codes, however, it is recommended to use the up-to-date ICD-10 codes.
    8. ICD-10 Start Date: Date when ICD-10 codes went into affect, not required.
    9. Injury Date Required: Check this box if the payer requires the Injury Date to appear on the claim. 
    10. Diagnosis change requires new plan of care: Check this box if the insurance requires a new plan of care when the primary diagnosis changes. Claims will appear on the Failed Charges report if the patient’s diagnosis is updated without completing a new POC.
    11. Authorization Required: Use the Authorization Required checkbox to automatically hold any claims that are missing authorization. These claims are placed on the Delayed Claims report and can be released from the Release Claim Delay page when the authorization has been added.
    12. Apply Speciality Modifiers: Check this box for payers that require specialty modifiers. This typically includes Medicare, payers that follow Medicare guidelines, and United Healthcare.
    13. Is Active: Uncheck this box to make the insurance inactive. Please note: Do not make the insurance inactive if there are current Active patients utilizing this insurance.
    14. Do not accept assignment: Check this box when the insurance does not accept assignments and should not receive claims.
    15. Available Contracts and Selected Contracts: This section is used for some integrations. You will not need to complete anything here. 
  5. Click Save.
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