Insurance Classes

An Insurance Class is a classification for financial reporting. Insurance Classes are primarily designed to group together insurances that have the same default billing requirements (i.e. require authorization). Multiple Insurance Classes can be linked to a payer, and the payer group determines how the claim is billed out (i.e. paper, electronic, etc.). 

We’ve found that while people rarely create new insurance classes, it is common to edit an existing insurance class description to make it easier to locate. For a downloadable list of our insurance classes, click here.

Edit An Insurance Class

1. Click Admin and select Insurance Classes.
2. Use the filters or simply click Search to locate the insurance class. The list of insurance classes will be automatically sorted in alphabetical order by Insurance Class Description. Or, you can click the New button to create a new insurance class (very uncommon). 
   
3. Double-click on the Insurance Class to edit.
4. Make any updates as needed using the definitions below. 
   1. Insurance Class Code: Identifies the insurance class itself, type in the desired code. Requires two digits, letters and numbers
   2. Insurance Class Description: Typically is the name of the insurance the class is related to
   3. Payment Code: Select the option that best describes the type of payment related to the insurance class. This is the default payment type on the Batch Payments page when posting payments for insurances related to this class. If needed, you can create a custom code for this field.
   4. Adjustment Code: Select the option that best identifies the type of adjustment that should be applied. This is the default adjustment type that appears on the Batch Payments and Batch Adjustments pages when posting payments for insurances related to this class. If needed, you can create a custom code for this field.
   5. Insurance Type: Select the type of insurance the class is related to.
   6. Audit Required: If checked, all charges related to insurances tied to this insurance class will automatically be placed on the Charge Audit report, and will not bill until manually released.
   7. Authorization Required: If selected, all insurances tied to the insurance class will require authorizations for all charges or they will appear on the Delayed Claims report until the authorization is added.
   8. Apply Specialty Modifiers: Check this box to automatically apply the GP, GN, GO modifiers to all charges related to this insurance class (this field is pending development).
   9. Apply Tax: This checkbox controls the automated processes that apply sales tax to the patient. This field can be mandatory or optional depending on the state (Minnesota).
   10. Apply Excise Tax: This checkbox controls the automated processes that apply tax to the insurance. This field can be mandatory or optional depending on the state (Hawaii).
   11. Enable Functional Reporting: Leave unchecked, this is a legacy feature.
   12. Enable MIPS: Leave unchecked, this is a legacy feature.
   13. Adjust Secondary Balance: Typically only used for Medicaid, this is when you do not want to bill any remaining balance to the patient. We do not recommend selecting this box for Medicare patients.
   14. Provider Credentials Required: Check this box when you need to hold claims for a specific Insurance Class when all Providers are waiting on credentials. Every insurance under the Insurance Class will be impacted. Select Ins Class Code Provider Credentialing delay description, if the Insurance Class is not one of the 5 government-based insurances.
   15. Delay Description: The Delay Description is required when the Provider Credentials Required box is checked. Select from the six delay options for the claim delay reason displayed on the Delayed Claims report. 
   16. Is Active: Will automatically be selected. Uncheck this box to deactivate an insurance class.
5. Click Save and you will receive a confirmation message. 
   

Search for Insurance Classes with Provider Credentials Required

1. Select Search to view a list of all Insurance Classes.
2. To filter search results by Provider Credentials Required, select the Filter icon next to Provider Credentials Required.
3.  Sort by true, then click Filter.
4. The list displays all Insurance Classes that have the Provider Credentials Required checked.