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Learning Center / Payors

2.2 Setting Payor Preferences (Part 1)

Each insurance company may wish you to provide information to them in a very specific method or make certain pieces of information mandatory. Furthermore, the manner in which Practice Perfect allows billing to these insurers (eg; from where in the software) can also be determined. Generally, these settings should be left alone unless otherwise requested.

 

There are two main area in which Payors may have special settings applied, Data preferences, relating to what information needs to accompany each claim along with specific billing-process restrictions and Billing preferences, which allows data to appear in specific formats on claims sent to the payors.

 

To make changes to the data required by each payor, click on the Data Preferences tab and the following screen will appear:

 

 

The first option is entitled Always Charge this Payor. This box should be ticked if you want zero-charges or zero-portions of charges to be shown on invoices for this payor. Whatever you enter into this field will be ignored by certain Invoice Styles – for example HCFA, eHCFA and EDI submissions always automatically submit the full charge, as per their definition.

 

 

Require Body Part…, Require Diagnostic Code…, Require Injury Code…, Require Service Location in service entry allows you to instruct Practice Perfect that, if a charge is going to this particular payor, that one or more of these codes is always required and entry cannot continue without that code being entered during treatment/service entry.

 

 

If Can’t bill from client screens is selected, invoices to this particular payor will not be able to be issued from the client’s activity views and only from the payor’s views. This is typically only enabled in the cases where electronic billing is possible.

 

 

Show Total Fee only on the invoices, forces invoices to this payor to reflect only the total charge that is being levied and not just their portion. A good example of when this option would be used is for an insurance company that only pays 80% of a bill but needs the bill to reflect the full 100% charge. Whatever you enter into this field will be ignored by certain Invoice Styles – for example HCFA, eHCFA and EDI submissions always automatically submit the full charge, as per their definition.

 

 

Tax Exempt, if selected, will force no sales tax to be applied to any invoices issued to this payor regardless of any other tax preferences that have been set within each Fee Code.

 

 

Do not show provider info, if selected, will prevent Practice Perfect from including information about the specific providers who rendered treatment on invoices and claims submissions directed towards this payor.