Insurance Set Maintenance

Use Insurance Set Maintenance to maintain additional information that an insurance carrier may need for processing billing claims for provider services.  If a provider performs services at multiple locations or within multiple departments the insurance carrier may require different provider billing numbers for each location or department.  You can maintain those additional numbers during this maintenance.

Tips:  

• Often, the Insurance Set Maintenance is used when you assign the same insurance codes for Medicare A and B and you need to maintain additional information to include on the UB92 forms and the UB04 forms when submitting institutional claims.

• In addition to Insurance Sets, you can maintain Group Sets, Location Sets, and Provider Sets for the additional information required for processing the billing claims for the provider services.

• For more information about working with data in fields, see the Data Entry Guidelines.

Directions:

To see directions for...

• Opening Insurance Set Maintenance, click More.

   

  1.  Click File Maintenance from the Menu Bar.

  2.  Click Standard Maintenance.

  3.  Click Insurance Maintenance.

  4.  Click Additional from the Insurance Maintenance Menu Bar.

  5.  Click Insurance Set.

   

  Insurance Set Maintenance Window Example:

  

   

• Creating a New Insurance Set, click More.

   

  To create a new record choose one of these methods:

  • Enter the new Insurance Code, Location Code, Department Code, Insurance Set and Sub Set (if applicable) then click Retrieve , or press [ENTER].
    Keyboard shortcut:  [ALT + t]

  • Or, enter the new Insurance Code and click File from the Menu Bar; next click New.
    Keyboard shortcut:  [ALT] [f] [n]

  Tip:  To indicate that you are building a new Insurance Set, New  displays near the Insurance Set.  Default entries display and the first field is highlighted to let you know you can begin entering information.

   

  Insurance Set Maintenance Prompts Tip:  To see more information about a field, click the hyperlink for the field name.
  Insurance Code	Enter the defined Insurance Code for the carrier. (up to 5 characters)
  Location	Enter the Location Code or press [TAB] to assign this information to all locations. (up to 2 characters)
  Department	Enter the Department Code or press [TAB] to assign this information to all departments. (up to 2 characters)
  Insurance Set	Enter the defined Insurance Set or press [TAB] to assign this information to all insurance sets. (up to 5 characters)
  Sub Set	Enter the defined Sub Set or press [TAB] to assign this information to all sub sets. (up to 2 characters) Notes:   You will maintain a sub set for billing special procedures for the provider. Often the carriers Harvard, Cigna and Aetna will require Insurance Sub Sets.
  	To update the new or changed information, click Save or press [ENTER]. Keyboard shortcut:  [ALT + s]
  	CAUTION To avoid losing data, you must save new or changed records.
  	To view all of the existing Insurance Sets, click Search.  From the Search list you can select the record to change or delete. Keyboard shortcut:  [ALT + r]
  	To display an existing Insurance Set, enter the Insurance Code, Location Code, Department Code, Insurance Set and Sub Set (if applicable) then click Retrieve, or press [ENTER]. Keyboard shortcut:  [ALT + t]
  Print Code	Enter the Print Code for the Insurance, if applicable. (up to 15 characters) Tip:  Generally you can maintain the provider's NPI as the Print Code.
  EMC Table ID	Enter the EMC Table ID for the insurance, if applicable. (up to 6 characters) Note:  Only maintain an EMC Table ID if you want to redirect claims to a different EMC Table or Payor ID.
  Payor ID	Enter the Insurance Code or Plan Contract Number, if applicable. (up to 20 characters)
  Medigap Number	Enter the Medigap Number for the Insurance, if applicable. (Up to 14 characters)

   

• Editing an Existing Insurance Set, click More.

   

  CAUTION:  To avoid losing data, you must save new or changed records.

  1.  To display the record to be changed, enter the appropriate Insurance Code, Location, Department, Insurance Set and Sub Set and click Retrieve , or press [ENTER].
  Keyboard shortcut:  [ALT + t]
  
  Tip:  If you do not know the Insurance Set, you can click Search  to see a list of Insurance sets.

  2.  To position the pointer to the information that you want to change, press [TAB] or click the field using the mouse.

  3.  Enter the data changes.

  4.  To complete the edit process, click Save , or press [ENTER].
  Keyboard shortcut:  [ALT + s]

   

• Deleting an Existing Insurance Set, click More.

   

  1.  To display the record to be deleted, enter the appropriate Insurance Code, Location, Department, Insurance Set and Sub Set and click Retrieve , or press [ENTER].
  Keyboard shortcut:  [ALT + t]
  Tip:  If you do not know the Insurance Set, you can click Search  to see a list of Insurance Sets.

  2.  Click File from the Menu Bar, and next click Delete.
  Keyboard shortcut:  [ALT] [f] [d]

  3.  At the Delete Records prompt, click Proceed to delete the record, or click Cancel to escape from the delete routine.

  Example:

  

   

  Note:  After you click Proceed, you will see the following message on the Status Bar.