How To Add or Edit Insurance Carriers

This form has all the details regarding each Carrier (Insurance Company). A carrier number will be automatically assigned.

Remember, you need to set up a new Carrier record if there is a different billing address for the Carrier. For instance, if you have been billing to Cigna at P.O. Box 1838 in Bismark, ND. (Carrier #2, for this example), for a particular patient and you discover that the Cigna office which actually processes this patient's claims should be P.O. 26102 in Greensboro, SC. We do not suggest you change the address for Carrier #2 as another patient's billing may be using this Carrier, and the ND address is correct for their claims. Instead, set up a new Carrier record for the new Cigna office for the patient.

Policies or Profiles of how this carrier pays

Carrier Specific Practitioner ID #s

Electronic Billing Information for ANSI transmission

Finance charge setup

Automated message settings

Claim form type for billing

Carrier Type

Carrier Name and Address

Fill in all of the fields that will be applicable for this carrier. Name, address, phone number are obvious. If you track your services and payments by carrier type fill in this field as well.

In TPS2000 you have the ability to "type" your carriers. By this we mean designate which financial category is applicable for a particular carrier. You may add types, or change the description of the User types listed. We have started you with the following list:

BC Blue Cross (EB)

GRP Group Type

HMO H M O Type

MB Medicare (EB)

MED Medicare Type

MM Major Medical Type

PA Public Assitance Type

PI Personal Injury Type

U1 User Misc1 Type

U2 User Misc2 Type

U3 User Misc3 Type

WC Work Comp Type

ZZ Other (EB)

If you will be using the 837 Professional Health Care form to electronically transmit the claims for this carrier, you need to select one of the carrier types that contain (EB).

The Claim form code refers to the template that will be used to fill out your preprinted HCFA or other billing form. Even if the carrier is Cash, this is the form you would use if an insurance company was being billed (NOTE: there is a Patient Super Bill format available that will print on plain paper should you wish to use this instead of a HCFA format).

There are 4 form templates in "TPS!" that print on the Red HCFA paper form. They are HCFA Work Comp/L&I Red, HCFA Red Med 1.7 (For Medicare), HCFA Red Med-WA (Medicare specifically for Washington State) and HCFA General Red 1.7 (This will be used for any other carrier needing a Red HCFA form).

HCFA General Red 1.7 will fill out the blanks on the Red HCFA form with the data requested by the field. In other words, if the block is titled Insured's ID number, then that is what will print on the HCFA form from our program.

HCFAWorkComp/L&I Red is identical to the HCFA General Red 1.7 except it prints the Provider's W.C./L&I number in box 33 UPIN field.

HCFA Red Med 1.7 and the HCFA Red Med-WA 1.7 are currently setup to meet the Federal Medicare Standards. What that means specifically, is that there will be no Carrier Name or Address printed at the top of the HCFA form. The word NONE will print in box 11 unless there is an insurance that is Primary to Medicare. The remaining boxes in 11 (a, b and c) will remain blank. The Diagnosis change date will fill into box 14 and the Last Xray Date or the Last Exam Date (which ever is more recent) will fill into box 19. The For Local Use Box 19 will also be preset to print in this area to hold any additional information required by Medicare in your state The related Diagnosis field (box 24E) will print a single digit. The Providers Medicare ID number will print in box 24K and in box 33.

For those clients that have the Electronic Billing module, you also have a choice of a Print Image file or the ANSI 837 Health Care Professional electronic submission form.

TPS 2000 will also track and generate automatic messages if your carrier needs Exams, Xrays or Report every so many days or visits. For example, if Medicare requires an exam every year, fill in “Re-Exam Days” with 365. Then let’s say that they also want Xrays every 5 years, you will fill in “Re-Xray Days” with 1825.

If you will be charging this carrier for a finance charge, fill in the annual percentage rate, if you will be charging a minimum charge fill in this field and the number of days before a charges is eligible to incur a finance charge.

Carrier and Doctor Specific Electronic

Transmission Information

Carrier ID and type for Doctor

Carrier Doctor Numbers

This button is used to pull up a screen that lists all of the Providers in your system. If you have a special provider ID number for this carrier for any or all of these Providers fill in their number here. This number will then be pulled into box 33 of the HCFA form. You may also select the type of ID number that this represents. For example, State License number or Provider UPIN, etc.

“EDI” stands for Electronic Data Interchange. It is the term used when electronically transmitting your claims. If you are setup to transmit your bills electronically, you will need to enter your mailbox and ID number here. There is also an area to fill out if you are using a billing service, clearing house or if this carrier requires you to first send claims through a re-pricing service.

Carrier Policies

You must add at least 1 policy for each carrier you use. A policy reflects what services are covered by this carrier and how they are paid. Deductibles, maximums and per visit co-pays are not taken into account when setting up a policy. For more information on customizing policies, see the How To “17.1 How to Customize Policies”.