The first step in creating a claim is creating the insurer. To do this, ensure you are logged into an account with at least Administrative Staff/All Billing Access permissions.
*Please note, this is for accounts subscribed to the Insurance Plan. If you don’t see the Insurers tab in your Settings, check out our Guide on Upgrading to the Insurance plan.
Create an Insurer
In the Settings tab, scroll down to the Insurers section on the left hand side.
Select ”New Insurer” from the top right, and then select the insurer type. Fill out the insurer’s information as required.
Important Note: If you’d like to bill using our EDI generation/download tool for submission, you’ll need to add the following fields to your insurer:
- Insurer Name
- Payer ID and/or Full Insurer Address
- Insurance Program
You may also enter a portal is appropriate. This could be a clearinghouse billing portal such as Office Ally, Trizetta, and/or Availity. This will allow you to launch the portal directly for claim submissions.
You can view some more information about managing claims and portals on this guide: Generating an EDI to Submit to a Clearinghouse.
Determine Patient’s Fee
When setting up your insurers, you’ll need to select the fields that you’d like to display when billing your insurance patient’s for this insurer.
The list of options includes:
Patient Pays Remaining (If you’d like Jane to by default pass what isn’t covered by insurance on to your patient)
Co-Pay ($ amount)
Deductible ($ amount)
Coinsurance ($ amount)
Percentage Coverage (% amount)
The actual amount you bill to each of your patients will be based on the coverage set on the claim you’ll create for each patient following this guide: Creating a Patient Claim (US)
You may also notice there is a Billing Codes First field when setting up your Health Insurance Insurers.
For more information on what this can be used for, please have a look at the following guide: Billing Codes First vs. Insurer Specific Codes
If you have any questions along the way, please email us at firstname.lastname@example.org to discuss your options.