Practice Manager Tips and Insurance News for December 2018
Reporting the CLIA # as Required by the Insurance Carrier for Laboratory Charges
When the insurance carrier requires the CLIA # to be submitted, check the following areas of PM to confirm your setup is correct.
1. Practice Screen (Administration -> Practice Tables -> Practice):
Enter the practice IH code and press enter.
Select Billing IDs and check to see if the CLIA # is set up under Billing Form NEIC_P5 or paper forms.
If the CLIA # is missing:
• On the Practice Screen, enter IH code
• Select Billing IDs
• Click NEW
• Override Key:
o Billing Form = NEIC_P5
o Insurance = IH code of the insurance carrier
• Override Data:
o Default CLIA# – enter the 10-digit CLIA #
• Add to List -> Close -> Save
Repeat these steps if the CLIA # needs to be added to more than one insurance carrier.
2. Type of Service Code (Administration -> Transaction Tables -> Types of Service):
The Billing Code MUST = 5
The Category MUST = Lab
• Enter IH code 5 and press enter (most practices use this IH code)
• Check to make sure the Billing code = 5 and the Category = LAB
• Click Save
When entering a charge requiring a CLIA #, use the IH code 5. The CLIA # will be included on the electronic claim or be listed on the CMS1500 form.
3. Facility Screen (Administration -> Practice Tables -> Facility):
NOTE: if your office has a unique CLIA # for each Facility, then you must enter the CLIA # in each facility IH code as applicable. If not, this area is not required to be completed.
Enter the facility IH code and press enter.
Select Billing IDs and check to see if the CLIA # is setup under Billing Form NEIC_P5 or paper forms.
If the CLIA # is missing:
• On the Facility Screen, enter IH Code
• Select Billing IDs
• Click NEW
• Override Key:
o Billing Form = NEIC_P5
o Insurance = IH code of the insurance carrier
• Override Data:
o CLIA# – enter the 10-digit CLIA #
• Add to List -> Close -> Save
Repeat these steps if the CLIA # needs to be added to more than one facility.
Contact Practice Manager Support if you have any questions or need assistance.
Need to send the same Narrative over and over on charges?
Did you know you can create and save a Narrative and eliminate retyping it?
Creating the Narrative:
• Click Administrative -> Transaction tables -> Narrative
• IH code = create a 3-digit code to label your narrative
• Description = enter a description of your narrative as follows:
• Narrative = type 19-up to 30 characters of data that you want to send with your charge; (do not use any punctuation). This will allow your information to be sent electronically or on paper.
Sample: 19-narrative test sample;
Attaching the Narrative on your charge(s):
While entering a charge or editing an existing charge, click the CUSTOM button
• In the Narrative window:
o IH Code – click the ‘eyeglass’, and click Find to locate your IH code
o Double click your IH code and the information will auto populate the Narrative window for you.
That’s it! This information will be sent electronically or on a paper form to the insurance carrier.
Bad Claims Report Error – ‘Medicare’ Missing Billing Instructions for ‘Why Medicare is Secondary’
Have you seen this error?
When a patient has Medicare as their secondary insurance, you are required to provide a code to Medicare explaining why.
Here’s what to check:
• On the Insurance screen, the Medicare IH insurance code must have MCR as the category.
• On the Patient screen: Insurance area (lower right) click on your Medicare secondary Insurance. The MORE button should be Highlighted. If not, you have not set up this subscriber to tell Medicare why his/her Medicare is secondary.
• Click the More button
• Click the down arrow. Your choices from Medicare are MC10 thru MC20
Here are the most common codes:
MC10 tells Medicare that the subscriber is of working age (65 or older)
MC16 tells Medicare that the subscriber is disabled (can be under 65)
You will need to decide which best fits the reason for each subscriber. There are nine codes to choose from. Call Practice Manager Support for assistance.
When you enter the charge for the patient, after entering the patient account number and the date of service, you will receive a pop-up stating that Custom data is attached to this charge. The CUSTOM button should be lit. Click OK to review the information.
• Billing Instruction Codes
1: should show the MC## information that is being carried over from the Patient. If it is not present, then no information was entered at the Patient level. You can enter the information here then go back and fix the patient screen.
Once completed click save to return to the main charge screen and don’t forget to save the charge too.
If this information is NOT on the charge and the subscriber has Medicare as a secondary insurance, then the claims will drop to the bad claims report.
If an incorrect ‘reason why Medicare is secondary’ is reported to Medicare, the subscriber’s claims will be denied on the EOB.