Create Insurance File

With the Create Insurance File function, you can scan every patient account for procedures that are to be submitted to insurance.

You can create the insurance file as many times as you want, but after you send your electronic claims, you will not be allowed to create the file again that day.

Data Field Information
Prompt Response Req Len
Create for All or Select Billing Groups Select the Billing Group option you want to create the insurance file. 1
Billing Group If you chose to create the insurance file for a Select Billing Group only, type the code you want or click the magnifying glass to search the table.   5
Insurance was last created through This field is informational only and reflects the date that the insurance file was last created.   10
Delete previously printed paper file If you want to delete the previously printed paper file, select this check box. If you select this check box, all claims that are in the paper claim file that have already been printed, will be deleted. If there are claims in the print file that have not been printed, they will not be deleted. This will not affect the electronic claims submission file. 1
Create through Date Type the date you want or click the calendar icon to select a date. This date refers to the accounting date that the charges were posted with. Any charge with an accounting date after this date, will remain in patient responsibility and will not have a claim generated. 10

The criteria that must be met for a procedure to be placed into either the print file or electronic file are:

  1. The Billing Group on the patient's account must match the billing group requested.
  2. The Bill to Insurance option in the Procedure Code Table must indicate that the procedure is to be filed to insurance.
  3. The procedure may not contain a flag in the patients transaction history indicating that it has already been filed to insurance.
  4. Either the Y (Yes) or the C (Courtesy) option must be selected for the Bill this Carrier field in the patients insurance record.
    If you selected Y, only those procedures being submitted to a primary carrier will be placed into the print file at this time.
    If you selected C the procedures being submitted to primary, secondary and tertiary carriers are immediately placed into the print file, but the claim submission activity is not stored in the patients insurance ledger.
  5. If you selected the N(No) option for the Bill this Carrier field in the patients insurance record, but you have selected the Override Ins. Billing check box in the Location Code Table for the location where the procedures were performed, the procedures will be placed into the print file.
  6. The procedure accounting date(s) must fall on or after the Effective Date contained in the patient's insurance record, and must also be prior to the Termination Date contained in the patient's insurance record (if one exists).
  7. If the procedure has a case record assigned to it, then the carrier specified for the case must meet the criteria listed above.

Every procedure that has met the above criteria will be placed in either the paper file or the electronic transmission file for processing. The procedures will be marked with either an F (paper file) or an E (electronic file) in the patients transaction history indicating that they were filed to insurance.
The amount owing on that procedure will be moved from patient responsibility to insurance liability depending on how the Ins Liability/Default Pmt% field is completed in the patient's insurance record. If this field is blank then 100% of the charge will be moved to insurance liability. If there is a percentage other than 100 in that field, it will move that percentage times the carrier's allowed amount to the insurance liability and leave the rest as patient responsibility. This amount will stay in insurance balance until the carrier either pays or denies the claim or the balance is manually transferred back to patient.

You may use the Create Insurance Status function to determine when this create process is complete.