How to set up a new insurance

This guide provides step-by-step instructions on how to set up a new insurance. It explains the different sections for organizing insurances and walks through the process of adding a new insurance, selecting the rendering provider for claims, choosing procedures, configuring services, and reviewing the setup. It also covers activating and editing configured insurances. With this guide, you can effectively manage the setup and configuration of insurances in the system, ensuring your agency.

1. To set up a new insurance click "Agency"

2. Click Insurances

Understanding the Insurance sections

3. Our system allows you to manage insurance providers effectively by organizing them into three main sections: Active Insurances, Draft, and Inactive Insurances.

• Active Insurances:

  This section lists all the insurances currently in use by your agency. Once an insurance is moved to this section, it becomes available for scheduling visits. While you can continue to make certain edits, such as adding modifiers to procedure codes, major changes cannot be made once the insurance is linked to a scheduled visit.

• Draft:

  The Draft section is where you configure new insurances. You can freely add and adjust details here until the insurance setup is complete. Once fully configured and approved, you can move the insurance to the Active section.

• Inactive Insurances:

  This section contains insurances that are no longer in use. You can move insurances here if they are no longer needed.[[ ]]While inactive, they can't be assigned to any new client.

Adding a new Insurance

4. To add a new insurance click this icon.

Step 1: Select the insurance

5. You can search for the Insurance by payer ID. You can also add a description to provide additional context or details about the insurance.

6. If you don’t find the insurance with the specific payer ID, you can add it manually by entering the necessary details.

Just select "Other", add the Insurance name, payer ID and description.

7. Once you have the insurance, click "NEXT"

Step 2: Select the Rendering Provider for Claims

8. Decide what information should be sent in the rendering provider section of the claim. You can choose from:

• NPI of the rendering provider who conducted the visit
• NPI of the case Lead Analyst
• Leave it blank

9. Click "NEXT"

Step 3: Select the Procedures

10. Choose the procedures or combinations of procedures and modifiers that you have received prior authorizations for. By default, our system includes:

• 97153 - Behavior treatment by protocol
• 97155 - Behavior treatment with protocol modification
• 97156 - Family training
• 97151 - Behavior identification - assessment

11. You can manually add more procedures as needed. Just click "Add Procedure"

12. Enter the procedure and the description, and click Add

Ex 97155 HN instead of 97155HN

13. Click "NEXT"

Step 4: Configure services assigned to each code

14. You need to assign specific services to each procedure code, ensuring that your scheduling and billing processes align with the services your agency offers

We will give some suggestions, but you can edit those fields and add new events by clicking "Add Event"

15. Select the Service for Each Code

For each procedure code, you need to assign a corresponding service. This service is what will appear on the calendar when scheduling visits, like:

• Behavior Treatment Session: Typically associated with the procedure code 97153.
• Family Training: Often linked to the procedure code 97156.
• Behavior Assessment Session: Usually tied to the procedure code 97151.
• Behavior Reassessment Session: Can be linked with codes used for reassessments.
• Supervision: Used for sessions where a BCaBA or Lead Analyst supervises.

16. Assign the Provider Role

After selecting the service, you'll assign which type of provider can schedule this event. This step is crucial for ensuring that only the appropriate employee can book specific types of sessions. You can choose from:

• Behavior Technician: Typically schedules sessions like Behavior Treatment.
• BCaBA: Can schedule sessions like Supervision or Behavior Reassessment.
• Lead Analyst: Typically has the ability to schedule any type of session, including assessments and supervisions.

This role-based assignment ensures that each service is linked to the right provider, maintaining compliance and organizational workflow.

17. Enter the Rate per 15 Minutes

For each service linked to a procedure code, you must enter the rate per 15-minute. This is crucial for accurate billing and ensures that the rates align with your agency’s contracts and agreements with payers.

18. Add Modifiers

Modifiers are used to provide additional details or conditions related to the service provided. You can add modifiers to the procedure codes based on the specific requirements of the insurance payer. Adding modifiers ensures that your claims are processed correctly and that you receive accurate reimbursement.

19. Click "NEXT" to edit the rest of the codes and follow the same steps

Step 5: Review

20. Once you’ve configured all necessary details, click "SUBMIT".

21. The insurance will remain in the Draft section where you can continue editing it as needed.

22. You can edit the information in all the steps, except for the insurance name and payer ID

Activating the Insurance

23. Once you are satisfied with the setup in the Draft section, you can move the insurance to the Active section.

Just click the three dots at the right side of the insurance you want to activate, and click "Make Active"

24. Click "Make Active"

Editing configured Insurances

25. If you need to edit an already configured insurance, just find the insurance you want to edit in the Active section.

26. Add Modifiers: Even after activation, you can still add modifiers to the procedure codes. This is particularly useful if new authorization requirements or billing guidelines emerge.

Add more events: You can also add more events

27. Remember, if the insurance has been used in scheduling, other aspects of the configuration will be locked. Only modifiers can be adjusted.