US Insurance Billing Additional Resources

​Missing Insurers Tab? Upgrading From the Base Plan to the Insurance Plan

Are you trying to set up your Insurers but the tab seems to missing? It sounds like you might be signed up for the Base plan, which doesn’t include the Insurance features.

🇺🇸 Integrated Claims with Claim.MD

🇺🇸 Secondary Claims in Jane

This guide walks through how you can manage patients that have secondary or supplemental insurance coverage - where the client has multiple insurance policies(i.e. primary and secondary insurance).

🇺🇸 Billing Secondary Insurance Claims

🇺🇸 What's an ERA in Insurance Billing?

ERA Management Tool FAQ

A paper or electronic transaction that includes adjudication information (who is paying for what) and payment information for one or more claims. A remittance includes a single payment amount - and parts of the payment amount are assigned to some but not necessarily all claims responses included ...

Posting Insurer Payments With Electronic Remittances (ERAs)

Show me the money! In this guide, we’ll walk through how you can post insurer payments using our ERA Management Tool by uploading electronic remittances (ERAs) to Jane. If you still have questions, you can visit our fully-loaded FAQ guide which we’re continuing to grow as well.

CMS1500 Reference Sheet

So you’ve generated your CMS1500 form in Jane. 🎉

Billing Under a Different Practitioner (Rendering Provider)

Sometimes, you might book a patient into one practitioner’s schedule, but you need to bill the patient’s claim to insurance under a different practitioner or Rendering Provider (Box 31 on the CMS1500). You might run into this scenario at your clinic if you employ students, recent graduates who ar...

Billing Unlisted CPT Codes to Insurance

Most services that you perform at your practice are represented by specific codes in the CPT code set. However, sometimes you might perform a treatment that isn’t represented in the CPT code set. This is usually only the case for newer or more unique services.

Cash Visits & Superbills

💡Heads up — this guide contains some workflows that are only available on the Thrive plan, and some that require Jane’s insurance billing features. We’ll let you know which workflows these are throughout the guide.

Collect Insurance Information on Intake Forms From Your Clients 📸

Jane offers a dedicated way for clients to upload photos of their insurance cards and provide their most basic insurance policy details in an intake form.

Courtesy Billing or Patient Pre-Pay (US)

Courtesy Billing refers to the workflow where your patients pay at the time of service, and you as the provider submit a claim to insurance on their behalf. Patients then receive reimbursement from insurance directly. For some clinics, it’s the Goldilocks of workflows that’s hits on a sweet spot ...

ICD-10 Code Set Updates FAQ

Every year, CMS updates the ICD-10 diagnosis code set. These yearly updates typically take effect on October 1st, and include additions of new billable codes, revisions of code descriptions, and the deletion of codes that are no longer valid or needed.

Insurance Claims & The CMS1500

If you are looking for a detailed breakdown of what needs to be included in each box of the CMS1500— and exactly how to enter that information into Jane— check out our CMS1500 Reference Sheet.

US Insurance FAQs & Troubleshooting

There are a number of different workflows in US insurance billing, so we’ve listed below some of the most common FAQs! We hope it helps, and as always, let us know if you have any additional questions we can help with.

Creating & Managing Good Faith Estimates in Jane

If you’d like to learn more about the No Surprises Act and Good Faith Estimates, you can check out this blog post.

Adding CPT & Diagnosis Codes to Charts

Jane’s goal is always to be helpful, and when it comes to documentation and insurance billing, that means being thorough, compliant, and efficient.

Setting a Place of Service Code

Hey there friend! If you need help setting a Place of Service (POS) code for claims that you’re billing to insurance, or for superbills that you’re providing to your clients, then you’ve come to the right place.

How do I reconcile insurance claim reversals?

Check out this guide to learn how to record and review these responses through Jane.

Posting Insurer Payments With Paper Remittances

This guide walks through how you can post insurer payments for paper remittances. If you have the option to receive electronic remittances (ERAs) from your insurer, you should definitely choose that option, and then check out our guide that walks through posting ERAs: Posting Insurer Payments Wit...

Posting Insurer Payments With Paper EOBs

You have submitted your claims in Jane and a couple of weeks have gone by – now insurance companies are mailing you cheques along with paper EOBs. Not sure how to record these payments in Jane? Continue reading!

Superbills on the Base Plan

💡Heads up — this guide is applicable for the Legacy Base Plan only.

Switching clearinghouses to Claim.MD

🇺🇸 Integrated Claims with Claim.MD - FAQs

If you have questions about working with Claim.MD in Jane, you’ve come to the right place. Here, you’ll find answers to some of the most commonly asked questions about Integrated Claims with Claim.MD, along with some helpful troubleshooting tips.

Box 16

If a claim is related to an injury that caused the patient to miss work, this box is used to indicate the date range where the patient was unable to work in their current occupation.

Box 24

Skip to the box you’re looking for:.

Box 11

This box is for the Insured’s Policy, Group, or FECA number (if applicable). Note that this is different than the patient’s Member/Subscriber ID.

Box 9

The Last Name, First Name, and Middle Initial of the Insured (Policyholder) for the Patient’s Secondary Insurance Policy.

Box 17

If the services rendered involved a Referring, Ordering, or Supervising provider, Box 17, Box 17a, and Box 17b are used to identify that additional provider.

Box 32

This box holds the Name, Address, and Zip code of the location where the services were rendered.

Box 12

This box contains the patient’s (or authorized person’s) signature. It is left blank if the patient does not authorize the release of their medical information to process the claim.

Box 13

This box indicates whether or not the provider has obtained explicit permission from the Insured (Policyholder) that authorizes payment of medical benefits to the party accepting assignment.

Box 1

Skip to the box you’re looking for:.

Box 10

This box indicates whether the patient’s illness or injury is related to their employment or an accident. For example, by checking the box labelled Employment (current or previous), the submitter indicates that the condition is related to the patient’s job or workplace.

Box 15

Box 15 is used to report another date (i.e. Last X-Ray) related to the patient’s condition. Similar to Box 14, this box includes a spot to enter a 3-digit qualifier to identify the date type being reported.

Box 21

This area is used to list a maximum of 12 diagnosis codes that describe the patient’s condition. The diagnosis code listed on Line A is considered the primary or principal diagnosis. Each diagnosis code is linked to at least one procedure (these links - or ‘pointers’ - are reported in Box 24E.

Box 22

This box is used to inform an Insurance company that the claim in question has been previously filed. This box has space for two pieces of information:

Box 29

The amount that the patient and/or other payer has already paid towards the claim.

Box 28

This box shows the Total Charge for all services rendered. It reflects the sum of the charges in Box 24F for all procedures on the claim.

Box 31

The first part of this box contains the credentials and name/signature of the rendering provider. By including their name, the rendering provider certifies that the information in the claim is correct. The second part includes the date that the form was signed.

Box 3

This box indicates the patient’s date of birth and legal sex.

Box 2

Forgive us for this one, but in the pursuit of being thorough: this box includes the patient’s full name. It will be entered as Last Name, followed by First Name, and then Middle Initial (if applicable).

The Top Right Corner

This area of the form holds the Legal Name and Full Address of the payer (Insurer) that is being billed. It indicates where the claim will be sent.

Box 4

This box indicates the full name of the person who holds the Insurance Policy (also known as the Insured).

Box 5

This box contains the patient’s full address and phone number.

Box 6

This box indicates the patient’s relationship to the Insured (the Policyholder). For example, if the patient is the Policyholder (their Policy Member ID is reported in box 1a), then check ‘Self’.

Box 7

This box indicates the address and phone number of the Insured (the Policyholder).

Box 14

This box is used to display the date on which the patient’s current illness, injury, or pregnancy began. The qualifier in this box indicates the type of date being recorded.

Box 18

If a patient is seeking treatment for a condition that resulted in a hospital admission— and the hospital admission and/or discharge dates are known to impact the payer’s adjudication process— then report the patient’s hospital Admission and/or Discharge dates.

Box 19

This box is used to communicate additional information about the patient’s condition or the claim.

Box 20

This box indicates whether or not the service was provided by an entity other than the billing provider. In Jane, ‘NO’ is always checked, and $0.00 is entered under the $ CHARGES section by default.

Box 23

This box contains the Payer Assigned Number that authorizes the services being billed. If applicable, enter the authorization number assigned by the Insurer for the current date of service. This is only required if the Insurance Company requires pre-authorization for patient encounters.

Box 25

This box is looking for the federal tax identification number and number type (either a Social Security Number or an Employer Identification Number). This is the tax identification number (TIN) for the entity to be paid for the submitted services (typically the billing provider).

Box 26

This box contains the number that the provider (clinic) uses to identify the patient.

Box 27

What this box is looking for varies by Insurance type and there doesn’t seem to be one clear definition - even for Medicare.

Box 33

This box contains the Billing Provider’s name, address, and phone number. This information lets the Insurance company know where to direct payment.

How to Unarchive an Insurer

Sometimes we create duplicates of insurers, or insurers that we only need to use for a short period. While those insurers can be archived, what happens if it needs to be used again?

Creating a Patient Insurance Policy (US)

To add a patient’s insurance policy, you can begin from two main areas; The patient’s profile or from their Appointment.

Re-booking Clients with the Same Insurance Info

If so, you can copy insurance information either when booking a patient visit or after the patient has booked to save yourself some time. This applies for both cash and insurance patients!

Adding Billing Codes to a Paid Invoice (to Create a Superbill)

If an appointment has already been paid for, and a client needs a Superbill, you can now add billing codes (with no price value) to a paid invoice.

Eligibility Checks with Claim.MD

This feature is currently in Alpha testing, so we haven’t put together a proper guide yet. Stay tuned, and please let our support team know if you have any questions in the meantime.