Setting Up Insurance Carriers

  • For multitenant environments, the following setup can be performed only by administrators of the parent company and is required only for the parent company. The parent company setup applies to all companies.
  • You must fill out all fields marked with an asterisk (*).
  • You can override some carrier information when setting up insurance plans. See Setting Up Insurance Plans.

To set up insurance carriers

  1. In AcuityLogic Admin, click Insurance and select Carrier.

    The Insurance Carrier window opens.

  2. To search for a specific carrier, select an insurance carrier from the Carrier Name drop-down list, and click Find.
    Search results include only active insurance carriers by default. To view both active and inactive insurance carriers, select All from the Active drop-down list.
  3. Do one of the following:
    • To create an insurance carrier, click Create New .

    • To modify an existing insurance carrier, click the link of the carrier in the Carrier Code column.

    The fields for creating or modifying the insurance carrier appear.

  4. Enter the carrier name in the Carrier Name field.
  5. Edit the carrier ID in the Carrier ID field if you want to change it from the autogenerated value. This is the ID that appears in the Carrier Code column on the Insurance Carrier window.
  6. Enter the name of the contact person at the insurance company in the Contact Person field.
  7. Enter 0 in the GL Receivable Number and GL Clearing Number fields, and leave the Term Date field blank. These areas are currently undergoing development and offer no functionality at this time.
  8. Select one of the following eligibility options for the carrier from the Eligibility drop-down list:
    • Eligibility and Authorization: You must record eligibility and authorization information for each transaction.
    • Eligibility: You must record eligibility information for each transaction.
  9. Select an authorization number format from the Auth Number Format drop-down list.

    The As, 9s, and dashes in each format represent the letters, digits, and dashes that the authorization number must comprise. For example:

    • A-999999999 (A1-N7): The format is one letter, a dash, and seven digits.
    • 9999 (N4): The format is four digits.
  10. Select an insurance ID format from the Insurance ID Format drop-down list.
  11. Select a billing method from the Billing Mode drop-down list.
    • Manual HCFA: All claims for this carrier come into AcuityLogic Billing with the status On Hold so that you can review the claims before manually billing them.
    • EDI 837: All claims for this carrier come into AcuityLogic Billing with the status Ready to Bill.
    • Statement: A safety statement is created for the claim in AcuityLogic Billing. Select this option only for carriers that require a notification when a patient applies the insurance to safety eyewear.
    • Web Billing: All claims for this carrier come into AcuityLogic Billing with the status Ready to Bill. AcuityLogic then automatically sends the claims to the carrier as part of a scheduled integration.
    • Review Claim: All claims for this carrier come into AcuityLogic Billing with the status On Hold so that you can review the claims before billing them.
  12. If you send claims to the insurance carrier through the VSP Interface, select Automated from the Eligibility Type drop-down list; otherwise, select Default.
    Depending on the insurance carrier, other options may display in the Eligibility Type drop-down list. Select the option that best fits the insurance carrier and your company.
  13. Enter the carrier’s website address in the Website Address field.
  14. Select an option for the eligibility expiration from the Eligibility Expiration Days drop-down list.
  15. Select either Version 08/05 or the revised Version 02/12 from the CMS 1500 Revision drop-down list.
  16. Record the date that the carrier will begin accepting ICD-10 diagnosis codes in the ICD-10 Acceptance Date field.
  17. Leave the EDI Payer ID field blank. This field is currently not used in AcuityLogic.
  18. Select Gateway EDI 837 (5010 Version) from the Transmission Info Id drop-down list.
  19. Select the No Receivable check box if you submit claims to the carrier but do not receive payments from that carrier. This option is useful when you are not contracted with the insurance company and collect payment in full from the patient but submit the claim as a courtesy.
  20. Select the Requires Form check box to set the status of a claim to On Hold after it is created in AcuityLogic Billing. While the claim is on hold, you can edit it as necessary. After you print the claim, the status is set to Billed.
  21. Leave the Active check box selected to set the status of the carrier to active.
  22. Select the Prepaid Carrier check box to configure the carrier as a prepaid carrier.
    AcuityLogic automatically sets the claim status for claims submitted to prepaid carriers to paid.
  23. Select the Medicare DMERC check box to indicate the carrier is a Medicare DME carrier. If you indicate the carrier is a Medicare DME carrier, AcuityLogic always sends the ordering provider information as part of your electronic claims submissions.
  24. Enter the carrier’s address and contact information in the appropriate fields in the Address Fields box.
  25. Use the HCFA Specific Fields to specify how to display information on the CMS 1500 form as follows:
    1. From the Billing Charge Amount drop-down list, select how the charge amount is calculated for box 24F on the CMS 1500 form.
    2. Select an insured ID type from the Insured ID drop-down list. The ID type determines which ID appears in box 1a on the CMS 1500 form.
    3. Select a group health type from the Group Health Type drop-down list. If the carrier is not Medicare or Medicaid, select Group Health. The selection appears in box 1 on the CMS 1500 form.
    4. Select an option for using Rx modifiers for the power of lenses from the Rx Modifier drop-down list. The Rx modifiers appear in box 24D on the CMS 1500 form.
      • Use Rx Modifier: Use the specific CPT power for the selected lens.
      • Do not use Rx Modifier: Use the first CPT code in the series (for example, SV - 2100) instead of the specific code for the power.
      • Use maximum Rx Modifier: Use the higher CPT code.
    5. If the right and left eye codes are identical, select the Combine Lens Base check box to combine them in one line item with a quantity of 2. If you do not select this check box, the right and left eye codes are always in two different line items. The line items are listed in section 24 on the CMS 1500 form, and the quantity appears in box 24G.
      You can select the Combine Lens Base check box only if the Split Lens Components check box is deselected.
    6. If the carrier is a Medicare DME carrier, select the Split Lens Components check box to automatically split the charge amounts, receivables, and copays for lens components (including lens base, coating, style, color, tint, edging, and miscellaneous extras) and for contact lenses. When you select this check box, AcuityLogic splits the items into two single (Qty=1) line items—one with the RT modifier and one with the LT modifier—in Medicare DME claims.

      • You can select the Split Lens Components check box only if the Combine Lens Base check box is deselected.

      • To be a Medicare DME carrier, the Medicare DMERC check box must be selected.

      • You must add RT and LT modifiers to your billing rules for items previously billed as pairs. See Setting Up Insurance Billing Rules.

    7. Select an NPI option from the Service Location NPI (CMS Box 32a) drop-down list. The service location NPI appears in box 32a on the CMS 1500 form.
    8. Select a billing NPI option from the Billing Provider NPI (CMS Box 33a) drop-down list. The billing provider NPI appears in box 33a on the CMS 1500 form.
    9. Select a place of service from the Place of Service drop-down list. The place of service appears in box 24B on the CMS 1500 form.
    10. Select the Bill Non-Covered Items check box to submit all line items on the CMS 1500 form, regardless of whether you receive a receivable from the insurance company for those items.
    11. Select one or both Billing based on material delivery options:
      • Put claims on hold until delivered: When this option is selected, claims created for orders are put on hold until the status for the orders is set to Delivered in POS. At that time, their claim status is changed to Ready to Bill. (If the patient has primary and secondary insurance, this rule applies only to the primary insurance.)
      • Switch service date to delivery date: When this option is selected, the service date is replaced by the delivery date throughout the claim in Billing, such as in the Service Date field at the top of the Claim Detail page and in the Date of Service fields in section 24 of the Edit Claim page.
      • You can select both options or only the first option. You cannot select only the second option.
      • If you select only the first option, the delivery date does not replace the service date in the claim.
      • In the Claim Detail window in Billing, new Claim History notes are automatically added for any status and service/delivery date changes made by this feature.
      • This feature does not apply to exam-only orders.
      If you turn this feature off by deselecting Put claims on hold until delivered, AcuityLogic does not automatically change all On Hold claims to Ready to Bill. Instead, you must manually review your On Hold claims—for example, by searching for Claim Status = On Hold in Billing's Claim Management tab or by running the On Hold Claim Report (GB112)—and change only qualified claims to Ready to Bill.
  26. Use the Custom Attributes area to add fields that must appear when you record a patient’s eligibility information in AcuityLogic POS. Adding attributes does not require you to record information for each attribute because each attribute is not applicable to each transaction. To add or modify custom attributes, follow these instructions:
    1. Do one of the following:
      • To add a new attribute, click Add Attributes.

      • To modify an existing attribute, click Edit.

    2. Select an attribute type from the Name drop-down list.
    3. Select a display order from the Display Order drop-down list.
    4. Select whether or not to display the attribute in AcuityLogic POS from the Display in Eligibility drop-down list.
    5. Select an attribute format requirement from the Format drop-down list if necessary.
    6. Enter an attribute value in the Value field if necessary.
    7. Do one of the following:
      • Click Insert to create a new attribute.

      • Click Update to update an existing attribute.

  27. To copy insurance rejection reasons from another insurance carrier:
    1. Click Copy Rejection Reasons.
    2. In the Copy Insurance Rejection Reasons window, select a carrier in the Carrier to copy from drop-down list.
    3. From the Rejection Reasons drop-down list, select one or more rejection reasons to copy.

      By default, all reasons are selected.

    4. From the Destination Companies drop-down list, select one or more companies to copy the rejection reasons to.

      By default, all companies are selected.

    5. Click Copy, and then click OK in the confirmation messages.
  28. Click Save.

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