The Insurance tab is to record the Provider's CMS-1500 insurance information used when completing insurance claims. The CMS-1500 claim field information is used to assist users in entering the appropriate information. Each field identifies the CMS-1500 field that it represents.
When a claim is created Filopto verifies the Insurance Type against this table and if it finds a match it will use the information entered in this table to complete the CMS-1500 form. All fields must be completed per the CMS-1500 regulations.
Refer to the CMS-1500 rules and regulations or the insurance manual of your Insurance payers for more details on what these fields can contain.
Medicare Participating Provider
If the selected provider is a Medicare Participating Provider, place a check mark in the box identifying that he is a Participating Medicate Provider. By placing a check mark, it tells Filopto Billing Rule engine to use the Medicare Participating Provider rates versus the non-participating provider rates when using the Medicare schedule entered in the Policy Fee Schedule billing rule option.
24j - Rendering NPI: is item 24J of the CMS-1500 form.
Item 32b & 33b: Only used in very rare cases and normally must be left blank or claims will be rejected. If you have to use these fields make certain that the insurance provider requires them. Review the CMS-1500 form requirements before making use of these fields. If you need to use these fields consider using the Insurance Provider Numbers (other than NPI) tab which can limits their use to a specific insurance company.
33a - Use which Billing NPI: is used to define if Filopto is to use the Rendering NPI or use the Office/Place of Service NPI entered in the System Setting for Insurance.
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Visit the federal government CMS web site for more information and up-to-date manuals on how to fill-out your CMS-1500 form. This site contains the official CMS 1500 Completion Manual.
Insurance Provider Numbers Tab
The Insurance Provider Numbers (other than NPI) tab provide a table in which Providers can record their insurance numbers for various insurance companies. This tab should only be used in exceptional cases when dealing with insurance companies not able to accept the Providers NPI.
Additional fields are provided to modify a claim for the given insurance company. The CMS field item 32b, item 33b and 24J (shaded area) can be modified to reflect specific needs of a given insurance company. DO NOT USE THESE FIELDS UNLESS INSTRUCTED TO DO SO BY THE SPECIFIC INSURANCE COMPANY. CLAIMS USING THESE FIELDS WILL NORMALLY BE REJECTED and the use of these fields is not consistent with the HIPAA or CMS-1500 rules and regulations. Note that in some states 24J shaded area may contain the providers Taxonomy Code.
