The Primary and Secondary (Guarantor) tabs of the Patient ability are used to enter the information of the person financially responsible for the Patient. The Primary tab is a required field and will need to be filled out with either the Patient information or the information of the party responsible for the Patient before saving.
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If the Guarantor for this account already exists as a Patient within MacPractice, use the magnifying glass next to the Last Name field to select an existing Patient or Guarantor for a new account. If you would like to erase the data within the tab, select the magnifying glass again and choose "Blank".
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Many of these fields will pull into CMS/ADA/CDA/UB Claim Forms, or can be added to Paper Forms, EMR/EDR Forms, EHR Forms, and Note Templates.
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Note: The information entered for the Primary and Secondary Guarantor will be the same for all Patients across an account. |
Within the Localization Preference, some offices may have "Use Canadian Claim Fields", this may adjust the name of some fields slightly.
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Primary/Secondary Demographics
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This information will be pulled into Box 4 and Box 9 (if the Patient has multiple insurance coverages) on the CMS Claim Form,
On the ADA Claim Form, the Guarantor's name will appear in Box 5 (if the Patient has multiple insurance coverages) and Box 12 on the ADA Claim Form.
This will also pull into Part 2 - Your Name Box of the CDA Claim Form and Box 58 on the UB Claim Form.
Many financial items work on an account level, such as statements, and will run based off of the name in the Primary tab. This would apply to things like the Statement Manager and some reports.
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Prefix and Suffix
These fields will be used if the Guarantors happens to have a Prefix or Suffix within their legal name. These fields are both optional.
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The Guarantor's address information will pull into Box 7 on the CMS Claim Form. As well as Box 5 (if the Patient has multiple insurance coverages) and Box 12 on the ADA Claim Form. However, this information does not display on the CDA or UB Claim Forms.
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If the Zip Code exists in the City State Zip Reference, entering the zip onto the Primary/Secondary tab will automatically fill in City and State fields.
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The Country field is designed for addresses outside of The United States. If the address is in the USA, US Territories, or Canada, this box should remain blank. This is especially important when working with eClaims, as incorrect codes will cause a rejection.
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Email Address
This is where the most reliable Email Address to contact the Guarantor should be entered.
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Enter up to three contact numbers per Guarantor. Enter the Phone Number without dashes; MacPractice will auto-format based on the format you have selected Preferences > Localization. For international offices, visit the Localization Preference and Localization Preference and change the Phone Format menu to "International".
Setting up the phone order in the Default Patient record is an important step for an office. The types of numbers can be set to Home Phone, Work Phone, Mobile Phone, or Other Phone.
On the CMS Claim Form, Box 7 will populate with the first listed phone number set to the "Home" phone type.
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This information will pull into Box 11a of the CMS Claim Form and Box 13 of the ADA Claim Form. This will also pull onto Part 2 - Your Date of Birth and Part 3 - Spouse Date of Birth of the CDA Claim Form. (if the Secondary tab is being used) of the CDA Claim Form.
The Guarantor's birthdate does not pull onto the UB Claim Form.
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This information will pull into Box 11a of the CMS Claim Form and Box 14 of the ADA Claim Form. The Guarantor's gender does not pull onto the CDA or UB Claim Forms.
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With Canadian and International claims, the Medicare or ID can be turned on in lieu of the Social Security Number field. Visit the Preferences > Localization > and change the SSN/Medicare drop down menu to your preferred choice.
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Once checked, this information will pull onto Box 12 of the CMS Claim Form, Box 36 of the ADA Claim Form, and Box 52 of the UB Claim Form.
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Signature on File Checkbox
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*Not present with Canadian Claim Fields checked.*
The Signature on File checkbox is the indicator that determines whether insurance benefits are to be received by the Provider or by the Patient. If checked, the benefits will be assigned to the provider. If unchecked, the benefits will be assigned to the patient.
This information will pull into Box 13 of the CMS Claim Form, Box 37 of the ADA Claim Form, and Box 53 of the UB Claim Form.
This field can also be added to a Form/Template in the form of "0" Unchecked and "1" Checked.
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Click the plus sign near the upper right corner of the Employers table. This will bring up a list of Employer References. Use the search field and select a record from the list. If the name is not present, use the plus button on the top right to create a new record then enter the Employer information and Address.
To have MacPractice prompt users to add an Insurance Carrier after adding the Employers information, go to Preferences > Patient Ability > Insurance tab > Check "Show related insurance after adding employer".
The Employer Name will be pulled into Box 17 on the ADA Claim Form. If added, the Group # will pull into Box 9 (if the Patient has multiple insurance coverages) and Box 16 as well. On the CMS Claim Form the Employer Name does not pull, but the Group # will be pulled into Box 9a (if the Patient has multiple insurance coverages) and Box 11.
For the CDA Claim Form the Employer Information will pull into the Part 2 - Employer area, and for the UB Claim Form this will pull into Box 65.
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Insurance Table
Many offices will use the Primary and Secondary tab to indicate Primary/Secondary Insurance, this is fine but keep in mind that these fields are defined as the Primary/Secondary Guarantor on the account.
For example, let's say the person financially responsible for the patient does not hold the Primary Insurance for them. In this case you would still add that person and their insurance information (if any) to the Primary tab. Then go to the Patient tab > Insurance sub-tab and click/drag the Primary Insurance to the top.
To add an Insurance Carrier to the Primary/Secondary tabs for this account, click the plus sign near the upper right corner of the Insurance table, which will bring up a list of Insurance Company References. Then search for a carrier and click "Select" to add Insurance to the account. If the record is not present, use the plus button to create a new one on the fly.
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There are a number of additional fields to fill out once insurance is selected. These columns may be rearranged by clicking and dragging the column headers.
Division/Section *Only present with Canadian Claim Fields checked.*
Sequence/Version *Only present with Canadian Claim Fields checked.*
Accepts Assignment Status *Only present with Canadian Claim Fields checked.*
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Carrier NameThis column will feature the name of the insurance company that has been selected. The order of the insurance listed here does not matter. To specify Primary and Secondary Insurance go to the Patient tab > Insurance sub-tab. Insurance Company and Address information is typically printed above the first boxes on the top margin of the CMS Claim Form. The Insurance Carrier Name will also populate into Box 9d (if the Patient has multiple insurance coverages) and Box 11c. On the ADA Claim Form the Insurance Company Name and Address will pull into Box 3 and Box 11 (if the Patient has multiple insurance coverages). The Insurance Company Name will also pull onto the CDA Claim Form in Part 2 - Name of Insurance Agency or Plan and Part 3 - Name of Other Insuring Agency or Plan (if the Patient has multiple insurance coverages). The Payor name will also pull into Box 58 on the UB Claim Form.  Subscriber #This field will be used to enter the Subscriber #. If the insurance assigns specific identification numbers to each Patient covered by an insurance that information is entered on the Patient tab > Insurance sub-tab, not here. For example, the general subscriber number is 12345, but each Patient has an identifier added to the number, such as 12345-A, 12345-B, 12345-C and so on. Once entered, the Subscriber # can pull into Box 1a and Box 9a (if the Patient has multiple insurance coverages) on the CMS Claim Forms. On the ADA Claim Form, this information can pull into Box 8 (if the Patient has multiple insurance coverages) and Box 15. This information also pull into Part 2 - Your Cert. No or S.I.M. or I.D. on the CDA Claim Form. As well as Box 8a and Box 60 on the UB Claim Form if the number pulls over to the Patient Tab > Insurance sub-tab.  Group #*Canadian Claim Fields Checked: Policy #* The Group # column will populate based on what was entered in the Group # field in the Insurance table. If a Group # is added to the Employer table and the Employer is selected in the Employer column, the Employer Group # will override the Insurance Group #. This information will pull into Box 9a (f the Patient has multiple insurance coverages) and Box 11 on the CMS Claim Forms. This will also pull into Box 9 (f the Patient has multiple insurance coverages) and Box 16 on the ADA Claim Forms. As well as Box 62 on the UB Claim Form. If Localization Preferences are enabled for Canadian claims, a Policy # field will replace the Group #. The Policy # will pull into Part 2 - Group Policy/Plan No. and Part 3 - Policy No (if the Patient has multiple insurance coverages) on the CDA Claim Form.  EmployerIf the insurance is provided through the Employer, select them from the pop-up menu.  PlanThe Plan can be selected from the drop down box. If the Patient's plan is not available in the list, a new plan can be added to References > Insurance Company > Plans tab. The Plan Name will pull into Box 61 on the UB Claim Form, but does not pull into the CMS, ADA, or CDA Claim Forms.  Start DateThe Start Date is the date the subscriber first gained this insurance. If the specific date is unknown, it is sufficient to enter a rough approximation, such as 1/1/2017. This information is not reported on claims, but it is used to allocate balances between the Insurance Portion and Patient Portion.  End DateThe End Date field should only be used if coverage terminates. This field is rarely filled out when first adding insurance to a Patient's record. Entering a date may cause problems, such as the insurance amounts not refreshing in MacPractice on the date of renewal. When the coverage is terminated, enter the date and then press the minus to archive the policy. If this date is not entered, an insurance company will still appear in lists or may show for claims.  Renewal DateEnter the month and day coverage refreshes in the Renewal Date field. MacPractice calculations assume the renewal is 01/01 if no date is entered.  Division/SectionIf Localization Preference are enabled for Canadian claims the Division/Section column will appear. Enter the Division or Section number related to the policy number, if applicable. This will pull into Part 2 - Division/Section No of the CDA Claim Form.  Sequence/VersionThe Sequence/Version column will also appear with the Canadian claims preference enabled. Enter the Sequence or Version number related to the policy number, if applicable.  Accepts Assignment StatusThis column will will also be available with the Canadian claims preference checked. This drop down defaults to "Use Insurance Setting", which will pull the option selected in the Reference ability > Insurance Company > Provider ID tab. If there is a case where the Insurance for the selected Guarantor does not match the Insurance Reference, you have the option to change it in the drop down to "Always Accept" or "Never Accept". For more information on Accept Assignments for claims, visit the HelpDesk article HERE.  |