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US Insurance Setup 1: Adding Your Insurers

  1. Insurance Billing Training (US)
  2. US Insurance Setup 1: Adding Your Insurers

    3. 8 min read
    Practice Plan Thrive Plan

Welcome! This lesson is the first step in setting up US insurance billing in Jane. Three steps 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 ☐

The first step is to add each insurer you plan to bill.


Instructions

Here’s how to create an insurer in Jane. The sections below explain some of the fields and settings on the form.

Creating the Insurer

📣 Heads up: Jane’s claim file formatting (EDI) doesn’t always work well with Availity for Medicare claims, so a different clearinghouse is recommended for those claims.

  1. Go to Settings.
  2. Scroll down to the Insurers section on the left-hand side.

The Settings page with the Insurers section in the left-hand menu

  1. Click New Insurer in the top right.
  2. Fill out the insurer’s information as required. To send claims electronically, add these fields:
    • Insurer Name
    • Payer ID
    • Insurance Program

The New Insurer form showing the insurer information fields The New Insurer form showing the remaining insurer fields

Insurer Address

  • If you’re sending CMS-1500 forms to the insurer, add the insurer’s address.
  • If you’re sending claims electronically, the address isn’t required.

Billing Portals

If you use Jane’s Clearinghouse Integration with Claim.MD, you can leave the Portal URL field empty, because claims go directly from Jane to the clearinghouse.

If you submit through Office Ally, TriZetto, or Availity instead, enter the clearinghouse’s web address in the Portal URL field. This lets you launch the clearinghouse’s portal directly from a patient’s insurance policy.

The Portal URL field on the New Insurer form

Treat CPT Units as Separate Line Items

Do you bill multiple units of the same procedure, for example, multiple units of massage? Some insurers treat each unit of a procedure individually, and others treat all units as a single or grouped line item. The way the insurer reports multiple units on its responses needs to match how they appear in Jane.

The Treat CPT Units as Separate Line Items checkbox on the New Insurer form

The Treat CPT Units as Separate Line Items checkbox sets how Jane displays multiple units of the same procedure:

  • When the checkbox isn’t selected (the default for new insurers), Jane treats multiple units of the same procedure as a single line item. Jane displays one Allowed Amount and one line on the EOB Screen for all units.

The EOB Screen showing a single Allowed Amount and one line for all units of a procedure

  • When the checkbox is selected, each unit has its own Allowed Amount and its own line item on the EOB Screen.

The EOB Screen showing a separate Allowed Amount and line item for each unit

If you receive an insurer response that splits each unit into separate line items, change the setting for that insurer so Jane matches the response:

  1. Go to Settings > Insurers.
  2. Click Edit to the right of the insurer.
  3. Select the Treat CPT Units as Separate Line Items checkbox.
  4. Click Save.

You’ll learn more about Allowed Amounts and managing insurer responses later in this training.

Insurer Submits Claims to Secondary Payers

Select the Insurer Submits Claims to Secondary Payers checkbox only if the insurer forwards claims to the secondary payer (Medicare, for example). When the checkbox is selected, submitting a primary claim to the insurer also moves any associated secondary claim to the Submitted folder in Jane. The checkbox doesn’t tell the insurer to forward the claim. It only moves the secondary claim into the Submitted folder in Jane.

The Insurer Submits Claims to Secondary Payers checkbox on the New Insurer form

Payer ID

The payer ID is key to getting your claims routed to the right place. Use one of these options:

  • Select the payer from the drop-down menu.
  • Enter the payer ID in the Other Payer ID field.

If you aren’t sure of the payer ID, check the payer ID your clearinghouse has on file for the insurer. The payer ID can also appear on the back of the patient’s insurance card.

The payer drop-down menu and the Other Payer ID field on the New Insurer form

🩵 Jane Tip: Each clearinghouse can have a different payer ID for the same insurer. To avoid claim routing delays, check Claim.MD’s payer list. If you use another clearinghouse, check that clearinghouse’s website for its list of payer IDs.

Saving Your Insurer

When you’ve finished entering the insurer’s details, click Create Insurer.

Repeat the steps in this lesson for each insurance company you bill. You don’t need to set up every insurer now. You can return to Settings > Insurers at any time to create a new insurer, for example, if you start treating a patient with insurance coverage you haven’t billed before.

🩵 Jane Tip: For any insurer you’ve set up, patients can upload a picture of their insurance card through their intake form. See our guide on How to Collect Insurance Information on an Intake Form.

What to Expect

After you click Create Insurer, Jane returns you to the Insurers page. The new insurer appears in the list.

Important Notes

  • Changing the Treat CPT Units as Separate Line Items checkbox for an existing insurer applies to invoices moving forward.

Amazing! One setup step down, two more to go.

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