Entering Your Insurer Plans, Referral Sources and Affiliations

 

Entering Your Insurer Plans

Referral Sources are medical organizations that direct patients to your practice for specific medical services or that your practice refers a patient to for medical services.

  • Go to BillingTracker > Settings > Insurer Plans.
  • Complete the Details.
  • Save.

This webinar includes a discussion of the various tabs and settings in Insurer Plans that you might find helpful:

Submitting and Resubmitting Claims Webinar

Entering a Referral Source

Referral sources are medical organizations that direct patients to your practice for specific medical services or that your practice refers a patient to for medical services.

  • Go To BillingTracker > Settings > Referral Sources.
  • Complete the Referral Information.
  • Save.

You can adjust the value displayed in Box 17 of the CMS-1500 form and Loop 2310A of electronic claims by selecting the Pre-Qualifier from the dropdown box:

  • DN - to indicate a referring provider
  • DK - to indicate an ordering provider
  • DQ - to indicate a supervising provider

Affiliations

Settings > Affiliations 

Affiliations are the relationships between billing providers and the insurers who represent patients. All Insurers assign a unique Provider Identification Number (PIN) to any organization that submits claims. Each practice will potentially have affiliations with many insurers. Each doctor will have individual affiliations with many insurers. Affiliations fall into seven groups or types:

  • Referral Source Affiliations assigned to referring doctors.
  • Clinician Affiliations are assigned to doctors who operate within the billing practice.
  • Practice Locations Affiliations are assigned to the practice. This is referred to as Group Affiliations.
  • Billing Provider Secondary ID This is an additional identification number that may be passed depending on the insurer's requirement.
  • Billing Location Secondary ID This is an additional identification number that may be passed depending on the insurer's requirement.
  • Clinician Referral Source Affiliations are used to meet certain regulations that may require a specific value to be passed to the Referral Source, in the case that there is not a Referral Source associated with the claim and the Rendering Provider is not licensed with the insurer.
  • Rendering Provider PCN (Provider Commercial Number) A new configuration form will populate REF*G2 in loop 2310B for Professional Claims.

Entering an Affiliation 

  • Go to Settings > Affiliations > .
  • Select an Insurer from the drop-down.
  • Enter a PIN.
  • Save.
Enter Bulk Affiliations Select the“*All Clinicians (Bulk Save)*” option (last entry in the Employee dropdown" If you select this option, you will be asked if you want to overwrite existing affiliations that match the bulk operation, or to only update missing records.

When a claim file is created, BillingTracker will look for a match between the resource and the insurer. If one is found, it will display the affiliation PIN. If not, it will search for a default value to use. The defaults come from the following locations:

  • Referral Source NPI from Referral record.
  • Employee NPI from ClinicTracker Staff Info record.
  • Practice Tax ID from ClinicTracker Building Setup maintenance item.
  • Billing Provider Secondary ID No Default.
  • Billing Location Secondary ID No Default.
  • Clinician Referral Sources No Default.

 

 

 

 

 

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