There are 3 steps that are required to get your account ready to use Jane’s Insurance features:
|Set Up Task||Task Complete|
|Adding Your Insurers||🥳|
|Assign Rates to Your CPT Codes||🥳|
|Location & Staff Billing Info||✍️|
Step 3: Location & Staff Billing Info
You’re almost ready to start billing! For paper (CMS-1500) and electronic (EDI Files) claim submissions, you’ll need to add some identifying information for your business, locations, and staff members.
There are two areas in Jane where you’ll need to add some claim-related information:
- Settings > Clinic Info & Locations
- Staff Profile(s).
- Staff Profile > Billing
Setting Up Claim Information in Location(s)
This information can be entered by heading into Settings > Clinic Info & Locations > Edit Location.
The following information is required for all claim submissions. Note: If you have multiple Locations, you’ll need to add this information to each:
- Location Name & Address (Box 32 on the CMS-1500)
- Location Billing Name & Address (Box 33** on the CMS-1500)
- Location/Service Facility NPI (Box 32a and Box 33a** on the CMS-1500)
- Place of Service Code (Box 24B on the CMS-1500)
** This box can be determined by the information in a Staff Member’s Billing settings instead of the location if needed. See the Overriding Location Claim Info With Staff Billing Settings section below for more details.
If you bill/provide superbills for some of your Treatments/Sessions under different POS codes, you can set a default POS code in your Location Settings for your most commonly billed code, and set specific codes in the Treatment/Session Settings for appointment types that need it. A super common version of this these days (especially for our friends working in Mental Health!) is offering both in-person and Telehealth services.
Setting Up Claim Information in Staff Profile(s)
This information can be entered by heading to Staff > Staff Profile > Billing.
The following information is required for claim submissions. It should be entered into the Default Claim Information section for each Staff Member who bills insurance.
- Rendering Provider Identifier - typically a Rendering Provider NPI (Box 24i and Box 24j on the CMS-1500)
- Tax ID & ID Type (Box 25 on the CMS-1500)
The following information is optional for claim submissions. This information only needs to be set if a staff member has been advised to do so by an insurance company, or if it is known to affect an insurance company’s adjudication process.
- Billing Provider Taxonomy Code (Box 33b on the CMS-1500)
Overriding Location Claim Info With Staff Billing Settings
If one or more Staff at your practice needs a little more flexibility with the information that’s sent on their claim submissions, then they can adjust their Default and Insurance Specific Claim Information.
For example, if a Staff Member is submitting claims as an individual, and would like to submit their own info instead of the location/business info in Box 33 and Box 33a on the CMS-1500, then they can set up Default Claim Info (if they need their claims set up like this for all or most insurers), or they can set up an Insurance Specific Claim Information form for a particular insurer (if only one insurance company requires this custom info).
Default Claim Information
In addition to the required and optional fields outlined in the ‘Setting Up Claim Information in Staff Profile(s)’ section, Jane gives each Staff Member the flexibility to add some custom claim information for fields that are otherwise set with information in the Location of the service.
Specifically, each staff member has the option to:
- Use a Custom Billing Provider NPI (Box 33a on the CMS-1500)
- Used instead of the Location NPI
- Set themselves up as the Billing Provider (Box 33 on the CMS-1500)
- Used in place of the Location Billing Legal Name
- Use a Custom Billing Provider Address (Box 33 on the CMS-1500)
- Used in place of the Billing Location Address
This information can be set up by heading into Staff > Staff Profile > Billing > Default Claim Information
Simply check the box for any areas that require customization, and enter the information as needed.
Insurance Specific Claim Information
Just like Default Claim Information, Jane gives each Staff Member the option to set up custom claim information that will only be used for claims sent to a particular insurance company.
For example, if there is one insurance company that requires that you submit a Taxonomy Code (and all other insurance companies you submit to don’t want your Taxonomy included in the submission), then you can create Insurance Specific Claim Information for that insurer.
This can be done within a staff member’s profile by heading to the Billing tab, and clicking the ‘Add New’ button under the Insurance Specific Claim Information section.
Select the insurance company you’re setting up the form for, and then enter your custom info as needed.
Note that by default, Jane will fill out the Insurance Specific Claim form with the information that’s currently present in your Default Claim Information. If there’s something you’ve included in your Default Claim Information (i.e. Taxonomy Code) that you’d like changed or omitted from the Insurance Specific form, then make sure to edit or remove it before saving.
Nice job – your account is now set up for insurance billing. 👏
Next up, start billing!!
📘 Get started here: Start Billing 1 - Entering Patient Insurance