Insurance Carrier Dictionary
The Insurance Carrier dictionary
contains the list of insurance carriers (payors) that will be referenced
in your organization. Also included in this dictionary is information
on what format should be used for claim submission.
Generally there will
be one listing for the carrier with multiple claim office and plans associated
to that carrier. Each insurance carrier
may have an unlimited number of claim offices
and plans. Insurance Contracts are assigned at the Plan Level (in the
Insurance Plan dictionary). The items entered in the Insurance Carrier
dictionary will be used in the Demographic, Financial Management, Revenue
Cycle Management, and Report modules.
The Insurance carrier dictionary
is a Partially shared (Business Group) dictionary. Items entered in this
dictionary will be displayed in the Insurance
carrier dictionary of all Business
Entities associated to the Business Group but will be required to be made
active and additional information will be needed upon activation.
This topic applies
to users of AmkaiOffice 3.17c or later. If you are on an earlier version,
see Insurance Carrier.
Have a list of the main Insurance Carriers
that will be most commonly referenced in your organization. Each
should include at least one claim office and one plan as a default.
If you are aware of any special reporting
requirements for specific carriers, you can customize standard claim forms
in the Administration module. See Claim
Customization.
Generally,
it is best to create only one entry for a carrier in the dictionary.
Claim offices and Plans will be associated to the Carrier to manage the
various types of plans and contracts associated to the Carrier.
- Click New Item from the
Actions sectionActions section
in the upper right of the dictionary. Complete the following fields.
- Name: Enter a
description of the item to be entered. This is a mandatory field and
must be unique.
- Quick Code: Enter a
short name for the item. Quick Codes can be up to 15 alphanumeric
characters,are mandatory and must be unique. If the Auto generate
quick codes Preference has been enabled, this filed will populate
when the Name field
has been completed and you tab off of the field.
- State Payor
ID: (optional)
Free text field to enter a State specific payor identification number.
- State Payor
ID 2: (optional) Free text field
to enter a second State specific payor identification number.
- EMC module: Select
the type of file to be created when electronic claims are generated
for this carrier. Options will include x12 Institutional and x12 Professional.
- Paper form: Select
the type of form to be used when paper claims are printed. Standard
selection options are HCFA 1500 02-12 or UB 04. All of the other forms
available in the drop down are situational and should only be selected
if instructed to do so by AmkaiSolutions Staff.
- Form Customization: This link
will open the Form Customization
screen for either the UB04 or CMS 1500
paper form. The system will display the customization screen based
on the form that has been selected in the Paper
from field. This screen will allow users
to modify many of the subjective fields on the paper claim to reflect
payor specific requirements. For more information on Form Customization see
the Claim
Customization.
- CF: If customization
changes have been made for this carrier the box will be checked. If
the box is blank, this indicates that no customization has been made
at the carrier level.
- ICD-10 Codes Needed
as of: Enter the date the Payor
switched from accepting ICD-9 to ICD-10 codes. As of the date entered
here, AmkaiOffice will automatically pull the ICD-10 code to the appropriate
fields when a case is billed for this carrier. If
an individual plan associated to the carrier requires ICD-10 codes
to be used as of a date that is different than the standard dated
entered at the carrier level you can specify that unique date at the
plan level. Dates only need to be entered at the plan level if the
date is different than the date set at the carrier level.
- Claim offices: At least
one Claim office is
required for each carrier entered in the Insurance
Carrier dictionary. When the carrier
is added as a new item a claim office must also be added. Additional
claim offices can be added here or can be added in the Claim office dictionary.
The system also allows for Claim
offices to be added “on the fly”
from the Demographic module when patients are being registered. One
Claim office will
be designated as the default office. The default Claim
office will be pulled to the Insurance
Policy screen when the carrier is selected at the patient level. The
Claim office can
then be modified as needed to reflect the correct office for the patient
being registered.
- To create a Claim
office click the and follow
the directions here.
- To add a Claim
office to an existing carrier
click the and
select a Claim Office
from the list displayed.
- To set a Claim
office as the default select
the Claim office in the list of offices associated to the
carrier and select Set
as default. The
Claim office will
then display with the word “Default” in the Claim
office list.
- Plans:
At least one Insurance
Plan is required for each
Insurance carrier entered
in the dictionary. When the carrier is added as a new item an
Insurance Plan must
also be added. Additional Insurance
Plans can be added here or can
be added in the Insurance Plan dictionary. The system also allows for Insurance
Plans to be added “on the fly”
from the Demographic module when patients are being registered. One
Insurance Plan will
be designated as the default plan. The default plan will be pulled
to the Insurance Policy screen when the carrier is selected at the
patient level. The Insurance Plan
selection can then be modified as needed
to reflect the plan associated to the current patient.
- To create an Insurance
Plan click the and follow
the directions here.
- To add an Insurance
Plan to an existing carrier
click on the and
select a plan from the list displayed.
- To set a plan as the default select
the plan in the list of offices associated to the carrier and
select Set
as default. The
Insurance Plan will
then display with the word “Default” in the plan list.
- Provider Insurance
Ids: This field is situational
and only requires data when instructed to enter in the field.
- Referring
Insurance Ids: This field is situational
and only requires data when instructed to enter in the field.
- Facility
Insurance Ids: This
field is situational and only requires data when instructed to enter
in the field.
- Physician
Facility Insurance Ids:
This field is situational and only requires
data when instructed to enter in the
field.
- Staff Insurance
Ids: This
field is situational and only requires data when instructed to enter
in the field.
- RCM Options: This field
is used to assign collector and follow up dates at the Insurance Carrier level.
For more information see the About
Revenue Cycle Management (RCM).
- State Codes:
For facilities located in an area of the
country with state mandatory reporting requirements, it may be necessary
to assign state specific codes to your Insurance carriers. Use this
table to assign those codes. Only users who have been instructed to
complete this area of the dictionary are required to enter data here.
- Generate
quick code: If
the Preference to Auto generate quick code has been set this field
will be displayed when new items are added to the dictionary. If a
quick code has not been set or if you would like to override the code
that has been entered in the field, click the button to have the system
generate a quick code.
- Click one of the following buttons:
To learn how to search, edit and activate/deactivate dictionary entries
and print a dictionary report, see
Editing
Dictionaries.