Pay Source – HIPAA 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.

Description

Description of the pay source. This field is completed automatically.

Assign Benefits

Select Y to assign benefits to the provider or N not to assign them. This information appears in Box 53 of the UB-04.

 Rel Infor

Select the release information code. The values indicate if the provider has on file a statement signed by the patient authorizing the release of medical data to other organizations. This information appears in Box 52 of the UB-04.

Patient Sign

Select the appropriate patient signature code that is used to indicate how the provider obtained the patient or subscriber authorization signatures and how they are retained by the provider if the No option is selected in the Rel Infor field. This information appears in Box 12 or 13 of the CMS-1500 claim form.

Program

Select the appropriate special program code under which the services rendered to the patient were performed. This applies to the entire claim. This information is included to the electronic billing format 837.

Medicare Assign

Select an appropriate medicare assignment code that indicates whether the provider accepts Medicare assignment. This information is included to the electronic billing format 837.