Insurance Billing in patientNOW

Since every practice is different, patientNOW offers different options for Insurance Billing. patientNOW provides you the tools to submit insurance claims (on paper or electronically), post payments, send statements and manage accounts receivable.

Your Responsibility for Insurance Billing.

To insure your success, you or your staff are responsible for the following:

• Understanding your insurance contracts. Are you contracted as an individual, with your social security number, or as a non-person entity, with a corporate tax id?
• Having the appropriate NPI numbers. If you are contracted as a non-person entity (e.g. a LLC or other group), you must have both an individual NPI, and a group NPI.
• Knowledge of CPT codes and best practices for your specialty.
• Understanding diagnosis codes, the correct version to use, and which codes require greater specificity.

Insurance billing can feel confusing and often seems that it has a language of its own. For additional information, check out Insurance Definitions.

Electronic Claims Submission

In medical billing, companies that function as intermediaries who forward claims information from healthcare providers to insurance payers are known as clearinghouses. In what is called claims scrubbing, clearinghouses check the claim for errors and verify that it is compatible with the payer software.

patientNOW uses Optum as an electronic claims clearinghouse. All claims and requests for Eligibility are sent to Optum and Optum redirects them to the appropriate Insurance plan. Each day, you may check claims status by logging on to the Message Center or Optum iEDI.

Paper Claims Submission

patientNOW will print an insurance claim on a CMS1500 form. You must purchase the forms separately, but may print them onto the forms. Once printed, the forms may be faxed or mailed to the insurance plans.

Provide Information for the Patient to Bill Insurance

In some cases, you may want to print a CMS1500, but if you do not have the forms, you may also use an Invoice Template and configure your procedures to have a CPT code attached. If you choose this method, you will still use Immediate Sale, Prepaid Package, and Surgery Invoice Types, but you can print a Billing Document that includes the CPT and ICD codes. Try the attached sample template,Billing Template with CPT and ICD Codes.

Note: In order for CPT Codes to show, you will need to attach CPT codes to your procedures.For additional information, check out Configuring Procedures If you wish for ICD codes to appear, you will need to add them to the patient in Patients | Clinical Information, Current Medical tab - Problem List/Diagnosis section.