Pay Source – General tab

P

Pay Source Insurance Pointer that is a system-generated identifier used to designate the order in which the payers are billed in pay control. Each payer added to pay source is assigned an alphabetic character. If the insurance is inactive for the selected date, the cell is highlighted in pink.

Code

Select the pay source insurance code for the patient. The available pay sources are defined in Administration > Financial > Insurance Codes. The pay source you select will appear on the Payers tab. If the insurance is inactive for the selected date, the cell is highlighted in pink.

Ins Co

Select the insurance company for this insurance code.

Company

Select the insurance company for the pay source. The available options are defined in Administration > Financial > Insurance Companies.

Note: This field is used only for the commercial insurance or with home health PPS MSP. If the code represents standard Medicare, Medicaid, Self Pay, or Uncollectible, this field is not used.

Plan

Select the insurance company plan for the pay source. 

Insurance plans are defined in Administration > Financial > Insurance Companies. Reimbursement rates for plans are defined in Administration > Financial > Insurance Plan Rates.

With a plan, an agency can create different reimbursement plans for a commercial insurance company's various reimbursement scenarios.

For example, an agency may have one plan that covers 75% and another— that covers 60%. To ensure that the appropriate amount of accounts receivable is generated, the agency can create two plans. A user can then select the appropriate plan upon entering the patient's payer information.

Group

Enter the group insurance ID number for the selected company. This number can typically be found on a patient's insurance card.

Insurance ID

Enter the patient's ID number for this payer. This number appears on the patient's insurance card.

Rel

Select the patient's relationship to the holder of the insurance policy from the Set Patient Relationship window. The identified relationship is used for Medicare, electronic billing for some Medicaid, and hard copy commercial UB-04 billing in locator 59 of the claim form and locator 6 of the CMS-1500 form.

Insured/Alias

Enter the name of the primary insured person if you selected an entry other than 01 in the Patient's Relationship to Insured Person field. You can also indicate the patient's guarantor or enter an alias name, the name under which the patient holds this insurance.

When entering an alias for a patient who is the primary insured, be aware that both the patient's name from Patient Basic and the alias name print on the bill.

• Box 12 (for UB-04 claims) contains the patient's name from Patient Basic;
• Box 58 contains the alias entered in this field.
• When the payer receives the bill with one name in Box 12 and another in Box 58, but the relationship is "self," the claim can be rejected.
• This is only an issue when the Patient Relationship to Insured is 01, Self.

Status

Select the P (pending) or A (active) status for the pay source. If the status is set to pending, a claim will not be generated for the patient or payer until it switches to active.

You can set the default value for this field to P in the Use field of Administration > Financial > Insurance Codes to ensure that the payer was reviewed prior to generating bills. This can reduce billing errors caused by invalid payers.

Billing Flag

Select the appropriate billing flag to note a patient who requires documentation to accompany the bill. As an example, visit records can be required for the patient's visits that are being billed. You can select P and the warnings appear on the Claim Alerts report.

Comment

Click the Comment field to enter the insurance related information and click OK.

Show Active Only

Select this check box to display only the active as of the current date pay sources. When the current date does not fall within pay source's date range, the record is hidden.

Effective Periods

Click the Effective Periods field, to define the effective and end dates for pay sources in the Effective Periods dialog. To access this field, you must have the appropriate privilege granted by your agency (Full Access or Read). A pay source may have several effective periods defined. The effective periods defined for each pay source do not impact claim generation. If a pay source has several effective periods defined, point to the Effective Periods field to view them.