Carrier Name

This 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.

Employer

If the insurance is provided through the Employer, select them from the pop-up menu.

Plan

The 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 Date

The 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 Date

The 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 Date

Enter 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/Section

If 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/Version

The 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 Status

This 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.