CARRIER (INSURANCE) CODES

OVERVIEW: The Carrier Codes Dictionary is used to record

the name and address of private carriers along

with their coverage definitions and payer ID number.

PROCEDURE: From the Dictionary Menu, select Option 6,

Carrier Codes, and press <ENTER KEY>.

EXAMPLE MENU:

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After you select (or CLICK) Option 6, the screen on the next page will be

Displayed.

ENTER CODE: Enter up to a ten-digit code (letters and/or numbers).

*If you intend to use the Combination Matrix, this code may not

exceed five characters. If this code is not on file, the following

message will be displayed at the bottom of your screen.

NOT ON FILE ADD? (Y=YES, N=NO)

If you do not want to add this code, type an N and press <ENTER KEY>.

The cursor will return to the ENTER CODE prompt.

If you do want to add this code, type a Y and press <ENTER KEY>.

The following screen will be displayed.

EXAMPLE SCREEN for Medicare Code MR:

DEFINITION OF FIELDS:

1. INS_NAME1: Enter the first line of the Company Name, up

to 35 characters, and press <ENTER KEY>. This is the name that

appears when searching.

2. LINE 2 OF INS_NAME: Enter the second line of the Company

Name, (or ATTN: someone) up to 35 characters, and press <ENTER KEY>.

If you only need to use one line, press <ENTER KEY> to leave line 2

blank.

3. INS_ADD1: Enter the first line of the address, up to

25 characters, and press <ENTER KEY>.

4. INS_ADD2: Enter the second line of the address, up to

25 characters, and press <ENTER KEY>.

5. INS_CITY: Enter the name of the City and press <ENTER KEY>.

6. INS_STZP: Enter the two-letter post office abbreviation

for the State followed by the zip code and press <ENTER KEY>. The

zip code field will hold up to nine numbers.

It is important to have the correct CITY/ZIPCODE to minimize rejections.

7. INS_TELE: Enter the area code first followed by the

telephone number. This field allows for entry of an

extension if necessary. If their is no extension, press

<ENTER KEY> after completing the telephone number to go to the

next field.

8. INS_CONT: Enter the name of the person to contact there.

9. INS_TYPE: Enter the type of insurance: BS MR MD WK or CO.

This is important.

BS = BLUE SHIELD

MR = MEDICARE

MD = MEDICAID

WK = WORKMAN'S COMP

C0 = COMMERCIAL

10. GRP_TO: Enter the group to group this carrier with on reports

(optional). Some reports will group carriers together. For

example, if you have 10 different Health Alliance Plan carriers, you could

put HAP (or anything) in this field and they'll be combined on the

report.

11. INS FORM: Enter the form/format to print hardcopy claims on

(usually CO). This determines the form/format to print the claim

in. BS=Blue Shield form, CO is Commercial HCFA 1500 form. MR is

also a HCFA 1500, but in Medicare format. This field is ignored

by UB92 billing. Most all carriers use ‘CO’ ( Basic Commercial Format )

12. TELECOM: Enter the telecommunication format, if any. This

isn't always an insurance type. It could be MR (for Medicare format)

or some other format type.

13. PRIM_Q: Enter the queue for primary claims (if blank,

claims go to the "1" queue).

14. SEC_Q: Enter the queue for secondary claims (if blank,

claims go to the "2" queue).

15. INS_COV: Enter default coverage (benefit) code for this carrier

(for Patient Information screen).

16. PMT_TX: Enter transaction to use for payment posting.

17. OUTPUT: Enter Y to bill line items with insurance balances,

N to not bill claims for this carrier, or A to bill all line

items regardless if there is a balance or not.

18. INS_MGAP: Enter this carrier's Medigap ID number.

19. INS_PAYOR: Enter this carrier's EDI payer ID.

ENTER THE PAYER CODE, USUALLY 5 DIGITS OR MORE. EXAMPLE 60054

20. HCF_ID_USE: Enter which provider ID field to use for billing.

If you leave it blank, system uses DR_PIN_NO from the Provider

Codes Dictionary. If you enter a label, it will use that label

and override the DR_PIN_NO. You may also enter a specific number

(whatever an insurance company wants you to use in Box 33 of the

HCFA 1500 form) or Attending Physician Loop for ANSI 837.

Provider Information Labels and Functions:

FIELD NO. LABEL FUNCTION

7. DR_PIN_NO PIN NUMBER

8. DR_GRP_NO GROUP NUMBER

9. DR_3RD_NO (USE FOR UPIN)

10. DR_4TH_NO Fields 10 through 12 may be used

11. DR_5TH_NO for other numbers such as Clia,

12. DR_6TH_NO License, etc.

21. ADDRESS: Print carrier address on hard copy form?

Y=Yes, N=No.

22. NONE_BLANK: If there is no other carrier: N=Print NONE in

Box 9/11, B=Leave box blank. This is for the HCFA 1500 form.

23. BOX_10D: For HCFA 1500. Indicate what to print in Box 10D

(if anything). Some states need information in this field.

24. BOX_17A: For HCFA 1500. Enter which field (label) in the

Referral Codes Dictionary goes in Box 17A. Enter the actual

field label from the Referral Codes Dictionary.

Referral Physician Labels and Functions:

LABEL FUNCTION

RF_BCBS BCBS PROVIDER NUMBER

RF_MR_UPIN MR UPIN NUMBER

RF_MDCR MR PROVIDER NUMBER

RF_MDCD MD PROVIDER NUMBER

RF_PRVT PRIVATE PROVIDER NUMBER

RF_LIC_NO LICENSE NUMBER

25. BOX 19: For HCFA 1500. This field is presently being used

for notes you may want printed on the form. To have the note

printed on the form, at this field type NOTE_ plus the code of

the note you entered in the Note Abbreviations Dictionary and

press <ENTER KEY>.

26. BOX_24E: For HCFA 1500. What should print in this column?

Do you want to enter a diagnosis code in Column 24E or a number

that will reference the diagnosis code found in Box 21.

C= Code, N= Number.

27. BOX_24K: For HCFA 1500. Enter which field (label) from the

Provider Codes Dictionary to print in Column 24K.

Provider Information Labels and Functions:

FIELD NO. LABEL FUNCTION

7. DR_PIN_NO PIN NUMBER

8. DR_GRP_NO GROUP NUMBER

9. DR_3RD_NO (USE FOR UPIN)

10. DR_4TH_NO Fields 10 through 12 may be used

11. DR_5TH_NO for other numbers such as Clia,

12. DR_6TH_NO License, etc.

28. BOX 33: For HCFA 1500, Box 33. (P)in number, (G)group

number, (B)oth, (O)verride Pin if Group. (P=Put PIN number

in Box 33 in PIN area, G=Put Group number in GROUP area,

B=Do Both, O=Use PIN number or print GROUP number instead if

there is one.)

29. HCFA_FLAGS: Special Handling Options:

9 = Populate all ITEM9 fields for Hardcopy

I = Include Legacy ID Numbers

i = Include Legacy ID Numbers for Secondary only.

N = Use external Provider Name

T = Include Taxonomy Code

30. INS_LINK: Enter the carrier code to use for UB92 billing if

different. This is for situations when a claim for UB92 billing

needs to be submitted to a different place than the HCFA 1500,

you are billing both forms. On the patient demographics

(Patient Information) screen, you use the in-house code of the

1500 processor. Then on the Carrier Codes Dictionary screen for

that processor, you put the in-house code of the UB92 processor

in the INS-LINK field. Since they are now ""linked", the UB92

form program will "swap in" the other carrier.

31. INS_UBID: Enter the carrier's UB92 ID code (if any). A few

carriers have an ID number that is placed next to their name in

the "payer" field on the UB92 form. For example, BCBSM's number

is G210, so you would put the "G210" in this field.

32. UB_ID_USE: Enter which provider ID field to use for billing.

(Reference same rules as HCF_ID_USE, Field 200.)

33. UB_COMP: Enter any carrier code that requires a complementary

ID number on UB92. A few carriers want the provider's ID number

for the complementary carrier. Put that other carrier's in-house

code in this field. For example, in Michigan, on a patient with

MR/BS, MR wants the provider number for BS reported. So, on the

MR entry in the Carrier Dictionary, you would put BS in this field.

34. UB_FLAGS: You may skip this field. It is for future use.

35. UB_VALUE: Enter value codes for this carrier.

Example: A1A2A38182

36. BILL_AMT: Enter the amount number from the Procedure Codes

Dictionary to bill this carrier. This is used for special carriers.

Do not use unless advised.

37. EXPT_AMT: Enter the amount number from the Procedure Codes

Dictionary you expect from the carrier. This used for special

carriers. Do not use unless advised.

38. PATN_AMT: Enter the amount number from the Procedure Codes

Dictionary to charge the patient (if not covered). This is

used for special carriers. Do not use unless advised.

39. SPLIT_OPT: Enter Y to charge the patient the difference

between the billed and expected amount.

40. DEDUCT_VST: Enter the maximum per visit deductible for this

carrier (if any).

41. DEDUCT_YR: Enter the maximum yearly deductible for this

carrier (if any).

42. DEDUCT_MAT: Enter the maximum deductible per matter (if any).

43. ANE_CODE: Anesthesia coding. A=Use anesthesia procedure code,

S=Use surgery procedure code.

44. ANE_CALC: Anesthesia calculation. (T)ime in units,

(M)inutes, (+)=time + base units.

45. ANE_DIAG: Anesthesia diagnosis, HCFA 1500, Column 24E.

1=Put a 1 there, D=Diagnosis Code.

46. ANE_TIME: Anesthesia time. (Y)es print start/stop time,

(M)inutes, (N)o don't print it.

47. ANE_DFM: Anesthesia defined modifier. Enter modifier.

48. COVERAGES: Enter list of all coverages valid for this carrier.

This is used in Patient Information, it checks this list for the

patient's primary carrier and issues a warning if patient's

coverage code isn't here. The warning is switched on/off by a software

toggle code COVLIST=YES or COVLIST=NO

After you have completed the various fields, an Action Line

will be displayed at the bottom of your screen. The next

page contains the definitions of the Action Line functions.

DEFINITIONS OF ACTION LINE FUNCTIONS:

ACTION-><Enter # to Correct,(P)rt,(F)wd,(B)ck,(K)py,(D)el,(V)fy,(N)xt,Esc=END

Enter # to Correct: Enter the number of the field you need to

correct and press <ENTER KEY>. The cursor will move to the first

character on that line (information on that line will not be

erased). You may retype the entire line, or position the cursor

on the character that needs correcting. Press <Home> to go back

to the Action Line.

(P)rint: Type P and press <ENTER KEY> to print a hard copy of the

information. The system will open a window in the middle of your

screen listing output devices. Please see the example below.

Type in the number of your selection at the flashing cursor

and press <ENTER KEY>. You may also use the <Up>/<Down> Arrow

keys to highlight your selection and then press <ENTER KEY>.

(F)orward: To go forward one code (numerically or alphabetically),

type F and press <ENTER KEY>.

(B)ack: To go back one code (numerically or alphabetically),

type and press <ENTER KEY>.

(K)opy: To make a copy of this information (be sure you O (zero)

and <ENTER KEY> to save it before you copy) and assign it a different

carrier code, type K and press <ENTER KEY>. The cursor will move to

the ENTER CODE prompt. Enter the in-house code of the carrier you

wish this information copied to and press <ENTER KEY>.

(D)elete: If you want to delete this carrier code from the

Search only, enter a D and press <ENTER KEY>. Do not delete an

insurance code that has been assigned a patient. If you are a super user

use the [R]emove command “R” to remove an insurance company from the

master file completely. Warning: An existing claim assigned to this code

will re-assign to another carrier after removing.

(V)erify: Type V to verify the original entry date and/or

the date this screen was last updated.

(N)ext: If there are more screens for the carrier you are

working with, the (N) function will open a window in the

middle of your screen and display them. You may make

your selection.

Esc=END: To save your entry and exit to the ENTER CODE prompt

type 0 (zero) and press <ENTER KEY>. You may enter more codes

or type O (zero) and press <ENTER KEY> again to go to the

Dictionary Menu.

Search: To search for a CARRIER, at the ENTER CODE prompt,

type a few letters of the carrier's name and press <Tab>.

A window will open up in the middle of the screen listing the

carriers beginning with the letters that you entered. You

may use the <Up>/<Down> Arrow keys to highlight your selection

and press <ENTER KEY>. You may also type the number that is to

the far left of your selection and press <ENTER KEY>.

Below is an example screen of a carrier search.

We have entered BLU.

EXAMPLE SCREEN

To exit the screen, type 0 (zero) and <ENTER KEY> or Escape.