Overview
While PIMSY cannot generate a paper claim, you have the ability of creating the payer and assigning it a specific payer number, which allows you the convenience of sending the claim with all your billing, without the hassle of typing up of HCFA or UB-04 form.
Required Permissions and Prerequisites
- Setting up your payer list is only available on the desktop platform.
- Please assign the Create, Modify, View, and Delete permissions for the following rule(s):
- Insurance Company
Step-by-Step Instructions
Step 1: Insurance Company Set Up
From the top navigation menu, go to:
Administration > Insurance Co., Payers, Charge Types
Step 2: Create the Payer That Requests the Paper Claim
To create a new payer, simply enter the name in the name field on the right panel and click Save. If you are partnered with ClaimMD, you want to assign Payer Number "PAPER" for the HCFA or UB-04 Payer number.
Step 3: Additional Fields
On the right-side panel, enter as much information as possible.
*Address and phone numbers are necessary if electronic secondary claims are filed.
-
Important Fields:
- Address - Enter the mailing address for the payer.
- Include on statement - controls whether a session billed under this payer should be calculated on a client's statement. Historically, Medicaid programs and other payers that prohibit billing client's directly should have this unchecked.
- Type Indicator - controls which type of funding source is identified on a claim form (equivalent to the radio buttons in box 1 on a CMS-1500 form). Please note, "Additional Charges" automatically go to Patient Responsibility in addition to any self pay charges for the sessions. This is often used when additional charges are added to a session fee (returned check fee, educational materials sold, etc.).
- Coding Requirements - controls which diagnosis code set to allow on the claim (DSM 5/10 after 2015 unless billing an EAP that allows ICD-9).
Step 4: Add Billing Codes (if applicable)
If tracking specific fee schedules for this specific payer, billing codes can be selected on the bottom half of this window. Additionally, fee schedules can be specified at different levels such as:
- Allowed Amounts by Modifiers - note this does not stamp the modifiers on the claim.
- Allowed Amounts by Title Category - an easy way to group one rate for all masters-level clinicians, interns or doctors.
- Allowed Amounts by User Title - can be used to bill / track expected amounts for an LPC and a different amount for an LMFT, for example.
- Default Amounts - used to bill or expect an amount for this payer that differs from the amount indicated on the company billing code setup
Step 5: Bill as Normal
Generate your claims as normal. When the claim gets to the clearinghouse, they will extract it and mail it to the payer for you.