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US Insurance Setup 3: Location & Staff Billing Information

  1. Insurance Billing Training (US)
  2. US Insurance Setup 3: Location & Staff Billing Information

    3. 10 min read
    Practice Plan Thrive Plan

Welcome back to the Jane US Insurance Billing training! This lesson is the third of three steps required to get your account ready to use Jane’s insurance features:

Set Up Task Status
Adding Your Insurers 🥳
Assign Rates to Your CPT Codes 🥳
Location & Staff Billing Info ✍️

In this lesson, you’ll add the identifying information that paper (CMS-1500) and electronic (EDI file) claims need for your business, locations, and staff members.

Jane has two areas for claim-related information:

  • Locations: Settings > Locations holds the default Service Facility and Billing Provider information.
  • Staff profiles: A staff member’s Billing tab holds the default Rendering Provider information.

Instructions

Here’s how to add claim information to your locations and staff profiles in Jane. Each section lists the steps, followed by what each field means and where it appears on the claim.

Setting Up Claim Information in Locations

📣 Heads up: If you have multiple locations, you’ll need to add this information to each one.

  1. Go to Settings > Locations.
  2. Click Edit next to the location.
  3. Enter the information in the fields described below.
  4. Click Save.

The Edit Location page showing the fields for the location’s claim information

Box numbers in this lesson, such as Box 33, refer to boxes on the CMS-1500 paper claim form.

Location Address (Required)

This address populates on claims as the Service Facility Address (Box 32) and the Billing Provider Address (Box 33). If your billing address is different from your service facility address, deselect the Use My Location Address for Billing checkbox and enter your billing address.

Legal Name (Required)

This name populates on claims as the Billing Provider Name (Box 33). Enter the name the way insurers recognize your clinic as the Billing Provider. The name should also match the name registered with your Billing Provider NPI.

Business Numbers / Tax Numbers (Optional)

These numbers appear on invoices, receipts, and statements. Claim submission doesn’t require them.

NPI (Billing Provider & Service Facility) (Required)

This is your default Service Facility NPI (Box 32a) and Billing Provider NPI (Box 33a). The NPI is typically your Type 2, Organization NPI, and it should match your Legal Name so insurers can accurately recognize your Billing Provider information. If you only have a Type 1, Individual NPI, you can enter it here, then follow the directions for Custom Billing Provider NPI in the staff profile sections below.

Billing Provider Taxonomy Code (Only if needed)

Enter your billing provider taxonomy code (Box 33b) here if every claim submission requires it. If only certain insurers require it, set it up in the staff member’s insurance specific claim information instead (see Setting Up Insurance Specific Claim Information below).

Tax ID Number (Required)

Enter your Tax ID Number (Box 25) based on how you’re contracted with insurers.

Tax ID Type (Required)

Select your Tax ID Type (Box 25) based on how you’re contracted with insurers.

Place of Service Code (Required)

Select your default place of service code (Box 24b) from the Place of service code drop-down menu.

The Place of service code drop-down menu in the Insurance Information section of the location settings

If you provide treatment under more than one place of service code, select your most commonly billed code as the default here. Then set specific codes for the appointment types that need to override the default. Go to Settings > Treatments, Classes & Group Appointments > Edit. For example, a practice that offers both in-person and Telehealth appointments can set the default for in-person appointments and a specific code for its Telehealth treatments.

The place of service code setting in the treatment settings

For more on place of service codes, see our guide on Setting a Place of Service Code.

Opening a Staff Member’s Billing Settings

The staff profile sections below start from the staff member’s Billing tab. To open it:

  1. Click Staff > Staff Profile.
  2. Click the Billing tab.

Staff billing settings are where you set the individual rendering provider information that populates on your claims, plus information for invoices, receipts, and superbills. You can also override the Billing Provider information from Settings > Locations here.

Adding ID Numbers (Optional)

ID numbers entered here appear on patient-facing documents, such as invoices, receipts, and superbills. They don’t appear on insurance claims. An ID number you add for a specific insurer appears only on that insurer’s receipts and invoices, and all other ID numbers appear on all receipts and invoices. To add an NPI or Tax ID for claims, use Default Claim Information instead.

  1. In the ID Numbers section, click Add.
  2. Select an insurer or an ID type (such as License, EIN, NPI, SSN, SIN, TIN, or Taxonomy) from the drop-down menu.
  3. Enter the number in the Number field.
  4. Click the checkmark icon.

The Add drop-down menu in the ID Numbers section of a staff member’s Billing tab, listing insurers and ID types

Setting Up Default Claim Information

The information entered under Default Claim Information populates on insurance claims for this staff member. Jane uses it for all insurers unless Insurance Specific Claim Information is also added.

  1. In the Default Claim Information section, click Add New.
  2. Enter the information in the fields described below.
  3. Click Save.

Rendering Provider Identifier (Required)

This is usually the provider’s individual Type 1 NPI (Box 24J), since the provider rendered the service.

📣 Heads up: Each staff member needs Default Claim Information with a Rendering Provider Identifier to submit claims. That identifier is the only field in the staff member’s billing settings that claim submission requires.

Tax ID Number, Box 25 (Only if needed)

If the Tax ID Number is in Settings > Locations, you don’t need to enter it here for claim submission, unless it should override the Tax ID for this provider. Also enter the Tax ID here if you plan to perform eligibility checks through Claim.MD under the individual staff member instead of the location. Whether you enter it here depends on how you’re contracted with insurers.

Taxonomy Code(s) (Only if needed)

Enter the provider’s taxonomy code here only if every insurer requires it on claim submissions for this provider.

Custom Billing Provider NPI, Box 33a (Only if needed)

Enter a Custom Billing Provider NPI here only if one of these applies:

  • The NPI should override the Billing Provider NPI you set in Settings > Locations.
  • You only have a Type 1, Individual NPI. Enter it here and select Type 1 from the drop-down menu.

Custom Billing Provider Name, Box 33 (Only if needed)

Enter a Custom Billing Provider Name here only if it should override the Billing Provider Name you set in Settings > Locations.

Custom Billing Provider Address, Box 33 (Only if needed)

Enter a Custom Billing Provider Address here only if it should override the Billing Provider Address you set in Settings > Locations.

Custom Rendering Provider Name (Only if needed)

Enter a Custom Rendering Provider Name here only if it should override the name on the staff member’s profile.

Setting Up Insurance Specific Claim Information

Like Default Claim Information, each staff member can have custom claim information that Jane uses only on claims sent to a particular insurance company. Enter information here only if it should be different from the Default Claim Information. For example, if one insurance company requires a taxonomy code, create insurance specific claim information for that insurer.

  1. In the Insurance Specific Claim Information section, click Add New.
  2. Select the insurance company you’re setting up the information for.
  3. Enter the custom information as needed.
  4. Click Save.

The Insurance Specific Claim Information form with an insurance company selected and custom claim fields

What to Expect

After you save, Jane uses the information on paper (CMS-1500) and electronic (EDI file) claims. Location information populates the Service Facility and Billing Provider boxes, and staff member information populates the Rendering Provider boxes. Insurance specific claim information is used only on claims sent to that insurer.

Important Notes

  • You can override Billing Provider information (Box 33) in a staff member’s billing settings, but Service Facility information (Box 32) always comes from Settings > Locations.

Nice job! Your account is now set up for insurance billing. Next up, start billing.

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