How to Add an Insurance Payer, Plans and Setup CMS Defaults
1. Admin > Setup > Insurances > Import Insurance
2. Select a Policy Type > Select an Insurance Payer from the list > Click Add button. You can search by Name or Payer ID as well.
3. If you need to create a custom insurance instead, select Create Custom Insurance
4. Enter Details > Save
A Payer ID is required if the insurance is eligible for electronic submission
Select the Hyperlink
Add a Plan if applicable > New Plan
- If you do not add a Plan, "None" will be the default and the Fee Schedule will be set to plan "None"
- If the payer has a different address, the Contact Info can be updated here.
Fill out the plan details in the Plan Details Tab > Save
You can use the dropdown to see all plans that have been setup for that carrier and view each Plan's details under the Plan Details tab
Select the CMS Defaults Tab
Enter in Information
For Box 23:
- When Box 23 is selected, an authorization number will be required on the RX Order
- The CLIA number will only drop in Box 23 for the selected CPT code.
For Box 24i:
- G2 - Provider Commercial Number
- ZZ - Provider Taxonomy (a list of valid Taxonomy codes)
For Box 32 and 33:
If an Alternate Service Facility Name or Alternate Billing Provider is entered in the CMS Defaults, that will override the Service Facility Name or Billing Provider name on the printed CMS 1500/837 EDI.