Insurance System Setup
In the system settings section, Insurance section, the default values used to complete the USA CMS-1500 can be modified to meet your particular needs. Review the default values provided and make any changes required.
Insurance Carrier Type : The default values for CMS claim filling. (CMS-1500 item 1)
User Define Insurance Group Names: The names of other non-standard insurance group names to be used for claim filling.
Electronic Claim Files Folder: The location to save the electronic claims uploaded for payment.
CMS 1500 - Place of service: The default place of services codes used in Claims
Place of Service Locations : Address for the places of service for claims submission. **** This is where you enter your Practice NPI ***
Insurance Reject Codes: Table that users can define reject codes and their meaning. Used for reporting and analysis purposes.
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The National Provider Identifier (NPI) is a 10-digit nationally assigned standard Identifier that will replace payer-specific identifiers for all healthcare providers no later than May 23, 2007. Individual healthcare providers are eligible for a single Type 1 Individual NPI. Healthcare organizations are eligible for a Type 2 Organization NPI.
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Group Practices are also eligible to obtain a Type 2 Organization NPI. HIPAA is mandating enrollment of Group Practices in order to maintain group affiliations with the individual practitioners. This is required so that the payor can identify situations where individual providers belong to more than one group, or where providers have their own practice as well as belonging to a group, and determine where to send payments in these situations.
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Healthcare organizations may also decide to subpart, or obtain multiple NPIs, based on location, unit, department, certification, licensure, or other billing and payment needs. How an organization subparts may impact how they bill, where payments are sent, and if they need to include taxonomy codes on their claim submissions.
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Although an NPI may correspond to several different service locations, the payor will only send payments for a single NPI to one Provider Name, one Payment Address, one Remittance Advice Address, one EFT Account Number, one Federal EIN (or SSN) for Tax/1099 purposes, and one Service Center/Receiver for electronic transactions outbound to the Provider.
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