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Billing Codes First vs. Insurer-Specific Billing Codes

What’s the difference??

Jane’s insurance work flow is designed to have billing codes added first, followed by your patient’s claim information.

For more information on our recommended insurance work flow, please have a look at the following guide doc: Adding Billing Codes and Insuring a Patient Visit

However, if your work flow requires that you need to place billing codes within your claims rather than outside (first), then there is a way to set that up!

If you are to set up your claims with insurer specific codes, please note that Jane will calculate the patient total differently than if you were to add your billing codes first.

For more information on how Jane will calculate your patient totals, please read on!

Billing Codes First

By default, when you head to the Insurance Info section of an appointment/purchase, you will see the option to add in a billing code before the visit has been insured.

Our recommended work flow is that you add your billing codes first:

If you add your billing codes first (outside/before any claims), Jane will set the treatment price based on the billing code rates, over-riding the original treatment price. As you can see in the clip above, the default or private treatment price for the visit is $75. When we added a billing code with an assigned rate of $100, Jane took the value of the billing code and updated the invoice accordingly ($75 –> $100).

This option was intended to allow clinics to bill any appointment amount to insurance as they are often different than private pay amounts.

If at this point we were to add a claim to the visit, Jane would use the $100 dollar price as a starting point to bill insurance.

Let’s say for this example that our patient has a policy with $30 Coinsurance. If we were to add that to our patient’s visit, Jane would invoice the payer for $70 and the patient would be responsible for the remaining $30.

Insurer Specific Billing Codes

If, instead, you need to add the claim first with billing codes contained inside, Jane will keep the original treatment price, bill the fee codes to the insurer, and then any remaining amount to the patient.

In order to add an insurer specific billing code, you will need add the claim to your visit first (before entering in any billing codes), select the arrow beside the claim you have added, and select the Add Insurer Specific Billing Codes option.

Once you have opted to add insurer specific codes, you will now be able to add your billing codes within your claim.

Pulling from our above example, let’s say our default treatment price is $75, and we were to add a $100 insurer specific billing code. Additionally, let’s say we set the Eligible Amount field to $50. This lets Jane know that of $100 that is being billed to the payer, the insurer will cover $50. If we have the Patient Pays Remaining toggle on, then the patient responsibility will be $25.

Here’s Jane’s math on that:

Original Treatment Price $75 - Insured Amount $50 = Patient Total $25

If the same visit were to have the billing code added first, then the patient total would be $50.

The math on that would be:

Price Determined By Billing Codes $100 - Insured Amount $50 = Patient Total $50

Pushing Billing Codes Outside of a Claim.

Have you added insurer specific billing codes and realized afterwards that you really want them added first?

If so, you can push your insurer specific billing codes outside of your claim by clicking the arrow beside your claim and selecting the Move Billing codes Above… option.

If you are attempting to move billing codes above for an appointment that has already been invoiced (marked as “Arrived”), then Jane will prompt you with a message to confirm that you would like to move your billing codes.

In some cases where payment has already been applied to the visit, Jane will not allow you to move your billing codes using this option. If this is the case, then you will first need to unapply any payments attached to the visit before you can move your billing codes. For a refreshed on how to unapply payment, please have a look at the following guide document: Unapplying a Payment

Copying a Visit With Insurer Specific Codes

If you have an appointment set up with insurer specific codes, and you would like to copy that claim set up to your patient’s next visit, you will need to make sure that your Insurer is set up to have the Billing Codes First field toggled off.

This field can be found by heading to Settings > Insurers > Edit

Please note that if you turn Billing Codes First off for your insurer, then all claims added for that insurer (for all patients) will be added without the option to add billing codes first.

Key Note: Both options, Billing Codes First and Insurer Specific Codes, will work for our EDI generation tool. However, you will not be able to generate an EDI for a visit that has both Billing Codes First and Insurer Specific Codes.

Related Guide: Creating an EDI File to Submit to a Clearinghouse

As always, let us know if you have any questions!