Maintain Insurance Carriers

With the Maintain Insurance Carriers function you can review information for a specific code, add new codes to the table, change the information for existing codes, print the table, and inactivate or reactivate a code.

Upon accessing this function, the Maintain Insurance Carriers screen displays containing blank data fields.

Data Field Information

Prompt	Response	Len
Insurance Carrier Code	Type the code you want or click the magnifying glass to search the table. This code cannot begin with a zero.	5
Insurance Carrier Name	Type the insurance carrier name.	60
Address Line One	Type the address for the insurance carrier.	40
Address Line Two	Type any additional address information.	40
Zip	Type the five digit zip code or the zip-plus-four. If you type the zip-plus-four CGM webPRACTICE will automatically insert the dash before the last four numbers.	10
City	Type the city for the insurance carrier.	25
State Code	The state automatically populates based on the Zip Code entered, or you can type a valid state code or select one from the list.	2
Country Code	Type a valid country code or select one from the list.	2
Subdivision		2
Payer Tax ID #	Type the Tax ID number for this carrier, if applicable.	20
Contact Individual	Type the name of the contact person for this insurance carrier.	30
Telephone Number	Type the phone number for this insurance carrier.	20
Fax	Type the fax number for this insurance carrier.	15
E-mail Address	Type the e-mail address of the contact person for this insurance carrier.	49
Website	Type the website of the carrier.	51
Insurance Form	Select the applicable insurance form type from the list.	2
UB Payer	If this insurance carrier requires facility charges to be filed on a UB form, select this check box.	1
Electronic Form Number	Select the applicable electronic form number from the list for this carrier. If current claims exist - change to this field is not allowed.	2
Force UB Claim to Paper	If this insurance carrier's UB claims are to be forced to paper, select this check box.	1
Default Insurance Type	For Medicare and Medicaid policies only. Select the Insurance Type you want to default into the Insurance Type field on the patient's insurance policy information screen for this carrier.	1
E-Secondary	If secondary claims can be filed electronically for this insurance carrier, select this check box. If you select this option, all secondary claims will automatically be included in the electronic claims file and will not print on paper claim forms. The prerequisites for this are that the secondary insurance policy on the patient's insurance information screen must be marked as Secondary and 'Y' must be selected in the Bill this Carrier field.	1
Claim Filing Indicator	Select the type of claim for this carrier. This code allows you to select a more specific type of claim indicator for 5010 claims. This value is sent in Loop 2000B and Loop 2320 SBR09 segment or Box 1 on the CMS form. If this field is not populated, the 'Insurance Form' selected for this carrier is used to determine the type of claim. If the carrier is Medicare - Professional, Claim Filing Indicator = "MB" If the carrier is Medicare - Institutional, Claim Filing Indicator = "MA" If the carrier is Medicaid, Claim Filing Indicator = "MC" If the carrier is Champus, Claim Filing Indicator = "CH" If the carrier is Workers Comp, Claim Filing Indicator = "WC" If the carrier is Blue Cross/Blue Shield, Claim Filing Indicator = "BL" Everything else - Claim Filing Indicator = "CI" One example why this field is necessary would be for Medicare Advantage/Commercial Medicare plans. If you have the Insurance Form set to Medicare (C), then 'MB' would be sent in the SBR09 segment or if the Insurance Form is set it to Commercial (F), then 'CI' would be sent. Either of these values would cause the claim to reject if you do not also have '16-HMO Medicare Risk' selected for the Claim Filing Indicator.	2
EPSDT Carrier	If this carrier is an EPSDT carrier, select this check box.	1
Equivalent Ins. Code	Type the code you want or select from the list. This list contains insurance names as stored in the Equivalent Insurance Name fields in CGM webPRACTICE Integration Options (System, Database Maintenance Menu). For additional information see the Equivalent Code help section under Introduction, System Processes.	1
Do not Bill to Insurance	If this carrier's claims are not to be billed to them, select this check box.	1
Insurance Class Code	Type the code you want or select from the Insurance Class list. The fee schedule in the Fee Schedule field must match the Fee Schedule stored with the selected Insurance Class code in the Insurance Class Table.	5
Auto Post Sec Adj	If you want secondary adjustments from the Electronic Remit to post, select this check box.	1
Fee Schedule (Allowable)	Type the code you want or select from the Fee Schedule list. If you want to automatically calculate write-off adjustments for this carrier during payment entry, you must select a fee schedule. If you select an Insurance Class code, this fee schedule must match the fee schedule stored with the selected Insurance Class in the Insurance Class Table.	5
Plan Code	Type the code you want or select from the Plan Code list.	3
Default Payment Code	Type the code you want to default for this insurance carrier during payment entry or click the magnifying glass to search the table.	5
Policy # Format	Enter the correct number format that staff members should use when completing the Policy Number field in the patient's Insurance Policy Information screen. You need to use the following characters to indicate the correct format: A = Alphabetical N = Numeric E = Any type of character P = Punctuation Whenever a number is typed in the Policy Number field, it is compared to this format to make sure it is correct. For example, if the policy number should be in the format of NNAAEEPA, then a policy number of 12AB3D-A would be accepted.	20
Auth Required	If this insurance carrier requires an authorization, select this check box.	1
Expected Pmt Days	If your practice uses the Insurance Collection module, type the number of days you must typically wait until you can expect to receive a payment from this insurance carrier.	3
Anesthesia Minutes per Unit	This field will default to the value stored in the Anesthesia Minutes per Unit field in the Insurance Billing section of the CGM webPRACTICE Default Values function; otherwise the field will be left blank. You can change the value as needed for individual insurance carriers. The hierarchy for determining the Anesthesia Minutes per Unit value when a claim is created: If a value has been stored in the Anesthesia Minutes per Unit field for the Insurance Carrier Code, it will be used. If a value has been stored in the Anesthesia Minutes per Unit field in the CGM webPRACTICE Default Values function, it will be used. The system standard of 15 minutes will be used.
Medigap Provider #	Type the Medigap Provider number for this carrier, if applicable.	15
Timely Filing Limit	If your practice uses the Insurance Collections module, type the number of days from the date of service that this insurance requires you to file a claim.	3
Add Physical Status Base Units	If you want the Anesthesia Physical Status Base units automatically added for this carrier, select this check box.
Electronic ID#	Type the electronic identification number for this carrier, if applicable.	20
Follow Up Letter	If your practice uses the Insurance Collections module, type the number of days since the insurance claim was filed for a follow up letter to be sent to the insurance carrier.	3
DME Place of Service
UB Electronic ID#	Type the electronic identification number for this carrier, if applicable.	20
Liability/Default Pmt %	Type the default insurance liability percentage followed by a forward slash '/' and then the default payment percentage for this carrier. This field is used for the default value for the Ins Liability/Default Pmt % field when entering a patient's insurance information. This is actually a two-part question. The first part - Liability determines what portion of a procedure should go in the insurance balance. If the entire balance is to remain in the insurance balance until the insurance pays, then the response should be 100. If you are collecting a portion at the time of service, the entry should be the portion that will remain in insurance balance. For example: if you are collecting 20% up front, the liability should be 80. The second portion – Default Pmt % is what percentage the carrier actually pays. These two responses should be separated by a forward slash '/'. For example, if this carrier was Medicare, and you do not collect any money at the time of visit, your entry should be '100/80'. This will be the default response for all Medicare patients being registered, thus maintaining consistency and eliminating errors. If you leave this field blank, the system treats it as if '100' was entered, which means the entire balance would remain in the insurance balance until the insurance pays.	7
Additional Payer ID#	Type the additional payer identification number for this carrier, if applicable.	20
HPID
Assignment Default	Select the Assignment Default option you want. This field sets the default value for the Accept Assignment field on the patient's Insurance Policy Information screen when registering patients with this insurance carrier. For more information see the Accept Assignment Protocol help section under Introduction, System Processes.	2
Comment	Type any necessary comment text.	45
Comment	Type any necessary comment text.	45
CGM webVERIFY Identifier	If your practice uses CGM webVERIFY, select the applicable identifier from the CGM webVERIFY Identifier list.	4
Eligibility Verification Frequency	If your practice uses CGM webVERIFY, you can select how often you want to run batch eligibility verification for this carrier. If you leave this field blank, 30 days is assumed. You can still run individual verifications as normal. When eligibility is checked for appointments on a schedule date, if a patient account has a policy with Eligibility Verification Frequency set to “Every visit”, the policy won’t be verified if it has already been verified using the Schedule > Verify Eligibility > Verify Eligibility within the last 60 days.	2
Verify when Payer is Secondary	If your practice uses CGM webVERIFY, you can enable eligibility to be checked for secondary policies in batches by selecting this check box.	1
PCCM Program	Community Health Centers only - If the insurance carrier is a 'Public Carrier, Managed Care Plan' or a 'Primary Care Case Management Program (PCCM)', select this check box.	1
Managed Care Plan	Community Health Centers only - if this carrier is a managed care plan, select this check box.	1
Public Insurance	Community Health Centers only - if this carrier is a Public Insurance Program, select this check box.	1
Typology Code	Community Health Centers only - if this carrier is a Public Insurance Program, select this check box.	1
5010 Format	This will display what items are being sent in the 5010 format, i.e. claims/remits, etc.	40
ICD-10 Activation
Use CMS-1500 (02/12)

After you Save the code, the information refreshes on the screen.

Inactive Codes - If you select a code that has been inactivated, CGM webPRACTICE displays the existing information for the code but the data fields will be unavailable and you cannot make any changes. Reactivate will be the only active function in the Action Column. You must reactivate the code before you can change any of the data stored for the code.

If you are the System Manager for CGM webPRACTICE, you should limit access to the Maintain function to select staff members. You should also provide guidelines (customized to your practice) to these staff members for entering table data in a consistent manner. This should protect the integrity of your table information.

Use the Action Column functions to edit or create codes. To create new codes or edit existing codes in the table, a user must have the Allow Table Update check box selected in Maintain Users under System, User Management, and be given the appropriate security level. For additional information about security levels, see the Function Security Menu under System, User Management. For setting up user codes, see Maintain Users. If the Maintain function is accessed and the user is not authorized to 'Allow Table Update', the New, Inactivate, Reactivate, and Save functions in the Action Column will be unavailable. These functions will appear dimmed on the screen and the user will only be allowed to Review codes. If the user does not have the appropriate security level to access the Maintain function, codes can also be reviewed using the Review an Insurance Carrier Code function.

Action Column Functions
The Action Column functions are provided so you can perform multiple functions quickly and efficiently from within the Maintain function.

Select - Displays a new screen with blank data fields so you can select another code.

New - Displays a new screen with blank data fields so you can enter the information for a new code.

Next - Displays the next code in the table. If you are viewing the last code in the table and click Next, CGM webPRACTICE returns to the main Tables menu. If you make changes to the table and click Next, the changes will not be saved. You must click Save to save the changes before proceeding to the next table item.

Previous - Displays the previous code in the table. If you are viewing the first code in the table and click Previous, CGM webPRACTICE returns to the main Tables menu. If you make changes to the table and click Previous, the changes will not be saved. You must click Save to save the changes before proceeding to the previous table item.

Print - You can print all or part of the contents of the table. For additional information on printing, see Print the Insurance Carrier Table.

Inactivate - Immediately inactivates any active code currently displayed on the screen. When you inactivate a code in the table, it is not actually removed from the table but is assigned an inactive status. CGM webPRACTICE needs to retain information about the inactivated code for any data that was previously entered with that code. After a code has been inactivated you cannot use it for any data entry operation. An entry will be logged in the Changes to Table category in the System Log under System, File Maintenance, Look-Up Functions.

Reactivate - Immediately reactivates any inactive code currently displayed on the screen and allows it to be used in data entry again.