What’s in the box?
What this box is looking for varies by Insurance type and there doesn’t seem to be one clear definition - even for Medicare.
That said, generally, if you check ‘Yes’ that means the provider agrees to be paid directly by the Insurer under the Insurer’s terms. If you check ‘No’, that means the provider wants the Insurer to send money directly to the patient.
Providers who are participating or contracted with an Insurer are required to follow the terms of the contract (which usually involves Accepting Assignment), but non-participating/out-of-network providers can choose what they’d like to do.
📌Key Note: There seems to be a relationship between Box 12, Box 13, and Box 27. This relationship can determine who gets reimbursed for the services (patient or provider). However, there is no clear definition of this relationship, so it’s best to contact specific Insurance companies to learn more.
Where does this info live in Jane?
There are two places in Jane that can determine how Box 27 is set on a claim submission:
1) Billing Settings
If you accept assignment for the majority of Insurance companies that you bill and would like to save a few clicks when creating new Insurance Policies, then you can set up Box 27 to default to ‘Yes’ for all new and existing Insurance Policies that don’t otherwise specify if you will be accepting assignment or not. This applies to all policies under all Insurers.
You can set this default by heading to Settings> Billing Settings> Accept Assignment and checking the box.
2) Patient Insurance Policy
When creating or editing an Insurance Policy (Patient Profile> Billing> Insurance Policies), you can specify whether or not you will be Accepting Assignment for claims submitted under the Policy.
Neither the ‘Yes’ or ‘No’ option is checked by default when creating a new Insurance Policy.
📍Pro Tip: If you have set Box 27 to default to ‘Yes’ (1), but when saving a patient’s individual Insurance Policy (2) you check ‘No’ (meaning you will not be accepting assignment for claims billed under this specific policy), then all claims billed under this Policy will be set as ‘No’.
Is this required?
You are required to specify whether or not you Accept Assignment for claims billed under a Policy, but that can either be done in Settings> Billing Settings or in the Policy itself.
What about the EDI file?
The Accept Assignment info is sent in Loop 2300 - Claim Info.
- If Accept Assignment is set to Yes, then a ‘A’ is sent in Loop 2300, Segment CLM07
- If Accept Assignment is set to No, then a ‘C’ is sent in Loop 2300, Segment CLM07
📌 Pro Tip: Patient’s With Secondary Insurance
If a patient has secondary Insurance, the Accept Assignment info that is set in the secondary Policy is included in the EDI file that is sent to the primary payer.
The Secondary (other) Policy Accept Assignment is sent in **Loop 2320, Other Subscriber Info, Segment OI03
Note: there is not a spot for this on the CMS1500.