Insurance Master List: Adding Insurance and Payer ID
Overview
Insurances can be added to your existing insurance payer database in zHealthEHR. Once entered, the insurance company information can be directly fetched into the Health Insurance Claim Form when submitting claims.
Insurance Configuration (General)
This section covers the basic and most commonly used insurance-related configurations and settings required for submitting electronic claims to the clearinghouse (Office Ally) or generating/printing paper claims.
 1. On the top right corner of the zHealth dashboard, you will see Your Name (Provider Name). Hover the cursor over your name, and click the Facility Settings option. |
| 2. On the new window, click the "Insurances tab" to see the list of insurance payor names and details. |
| 3. To prevent duplication, try to find the insurance company name first using the Search box at the top right corner. a. If the insurance payer already exists, click on the Edit icon under Actions to review and edit the payer information as required. b. If the insurance is not in the system, click Add Insurance button. A pop-up window opens. Continue to the next steps. |
| 4. Enter all the information as listed below: a. Insurance Name: Enter the insurance payer name. b. Payor Id: Enter the Payor ID number. (You can find the Payor ID of an Insurance Company at this link.) c. Enter the *Claim Filing Indicator Code (Box 1). This code identifies whether the primary payer is Medicare, Medicaid or any other private payer.  *Note: Box #1 in the HCFA Form will automatically pull the claim filing indicator code if you've filled in the code while creating a new insurance. |
| d. Accept Reassignment: This information goes into Box 27 of the HCFA form. Box 27 is used to indicate that the provider agrees to accept assignment under the terms of the payer’s program. From the drop-down menu, you can select either “Provider accept assignment code*” or “Assignment accepted on clinical lab services only”. You can also select "Not Assigned" depending on your services. *Note: When accepting an assignment, the beneficiary may be billed for the 20% coinsurance, any unmet deductible and for services that are not covered by Medicare. The difference between the billed amount and the Medicare-approved amount cannot be billed. The 20% coinsurance is based on 20% of the Medicare-approved amount (not 20% of the billed amount). |
| e. Address: The insurance address, city, state, and zip code where claims should be sent. This is required for electronic and paper claims submission. (This is optional as the Payor ID will pull this information automatically) f. Phone Number: Enter the phone number of the insurance payor. (This is optional as the Payor ID will pull this information automatically) g. Claim Submit: Depending on whether the insurance company accepts paper or EDI claims, you can select one option from the drop-down menu. h. Other ID - HCFA 1500 Box 24I: It is the qualifier that corresponds to the provider ID type. From the drop-down menu, select the option applicable for the insurance payer. (Check your previous HCFA form for this insurance company to fill this field) i and j. Keep HCFA 1500 Box 32 and HCFA 1500 Box 32a empty. |
| 5. From the drop-down menu, select the option applicable for Other ID HCFA 1500 Box 32B (It is the non-NPI identity of the Provider). |
| 6. From the drop-down menu, select the option applicable for Billing Provider Other ID - HCFA 1500 Box 33B (It is the non-NPI identity of the Billing provider). (Check your previous HCFA form for this insurance company to fill this field. |
| 7. From the Clearing House drop-down menu, select the clearinghouse. This is the clearing house zHealthEHR has partnered with for processing submitted claims.  Note: The user can ignore this field. |
| 8. In this field, enter the unique identifier for the insurance company. |
| 9. You can fill in the Advanced Options to provide information about your entity type. Two categories of healthcare providers exist for NPI enumeration purposes: Entity Type 1 (Individual) and Entity Type 2 (Organization). Individual healthcare providers may get NPIs as an Individual Entity Type. As a sole proprietor, you must apply for the NPI using your own SSN, not an Employer Identification Number (EIN) even if you have an EIN. Organization healthcare providers are group healthcare providers eligible for NPIs as Organization Entity Type. Based on whether you have an Individual or Organization NPI Entity Type, fill in the following details under Advanced Options. a. *From the drop-down menus, select the entity type for CMS-1500 Box 32 and CMS-1500 Box 32a. b. From the drop-down menus, select CMS-1500 Entity Type 33 (including Box 25), CMS-1500 Entity Type 33a and CMS-1500 Entity Type 33b. *Note: Please do not update the fields for Entity Type 32 and Entity Type 32a unless you know how they affect the claims. |
| 10. Under the Advanced Options section, enter the appropriate Legacy Provider (Medicaid) ID Number if you've selected "1D - Medicaid Provider Number" in the Other ID - HCFA 1500 Box 24I (shaded). |
| 11. Review all the information you have added to the new insurance and then click Save. The new insurance will be added to the insurance master list. |
Insurance Configuration (E&B Verification)
Each insurance requires additional configuration details to allow the practice to send eligibility verification requests to the payer through the clearinghouse (Claim MD).
 Ensure that the insurance for which the practice is sending the Eligibility Verification request has a Claim MD Payer ID linked. To do this, navigate to the "Insurance tab", click the "Edit" icon next to the payer name, go to the "Claim MD Payer ID" field, and enter the payer name or payer id. It will populate the payer details in the dropdown list. Select the correct payer from the dropdown to link it. Note: This is a one-time setup and needs to be completed only once before sending an E&B Verification request to the payer. The Claim MD Payer ID field will be available only when the Eligibility and Benefits (E&B) Verification feature is enabled in your system. |
Do you still have questions? Feel free to contact our support team or write to us at support@zhealthehr.comRelated Articles
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