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: Review the Billing Provider Information

8. In the Billing Provider section, please review, and change if necessary, the fields to ensure they contain accurate details about the billing provider. This includes:

  • Provider Name: Name of the billing provider.
  • Billing Provider EIN
  • NPI (National Provider Identifier): Provider's unique identification number.
  • Address: Complete address, including city, state, and zip code.
  • Phone Number: Contact number for the billing provider.
  • Billing Provider Taxonomy: Verify the taxonomy code aligns with the provider's classification.

After confirming that all the information is accurate and up to date, click Next to proceed to the third section.

By default, the information in this section will match with the agency's information in the system.

Step 3: Select the Rendering Provider for Claims

9. 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

If you select "The NPI of the Case Lead Analyst" you must assign a Case Lead Analyst to each client covered by that insurance. This information will be sent to Billing based on the designated lead analyst for each case.

10. To assign a Case Lead, go to the client's profile, navigate to the Insurance section, select the insurance, and choose the Case Lead.

Step 4: Supervising Provider

11. To answer the question "Do you want to include the case supervising provider in the claims?", follow these steps:

  1. If you want to include the information of the case supervising provider in the claims, select Yes and click Next to proceed.
  2. If you do not want to include the case supervising provider, select No and then click Next to continue.

If you select Yes, you must select a Supervising provider for each client covered by that insurance. This information will be sent to Billing based on the designated supervising for each case.

12. To select the Supervising provider, go to the client's profile, navigate to the Insurance section, select the insurance, and choose the provider.

Step 5: Select the Procedures

13. 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)
  • 97155 HN (Behavior treatment with protocol modification)
  • 97156 (Family training)
  • 97156 HN (Family training)
  • 97151 (Behavior identification - assessment)
  • 97151 TS (Behavior identification - reassessment)

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

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

For combinations of procedure and modifier, the procedure and the modifier should be separated by a space.

Ex 97155 HN instead of 97155HN

16. Click "NEXT"

Step 6: Configure services assigned to each code

17. 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.

18. Click "Add Event" to add events.

19. 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.

20. 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.

21. 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.

You have to type only the amount, don't add the "/ 15 min" part

22. Click "Add Event" to add events.

23. 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.

Please add only the optional modifiers that are not part of the prior authorization codes here. Staff members will be able to select these modifiers when creating a visit.

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

Step 7: Review

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

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

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

3. Activating the Insurance

28. 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"

29. Click "Make Active"

After the insurance is activated, it will be available for scheduling.

4. Editing configured Insurances

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

You can continue editing the insurance configuration in the Active section as long as no visits have been scheduled. Once a visit is scheduled, some elements will no longer be editable. You will still be able to edit the following:

  • Insurance name
  • Payer ID
  • Description
  • Billing provider information
  • Rendering provider
  • Supervising provider

Additionally, you can continue adding procedures, service events, and modifiers.

Edit Insurance Name, Payer ID, and Description

31. Make the necessary modifications, then click "Next" until reaching the "Save" button at the end of the insurance configuration.

Edit Billing Provider Information

32. Make the necessary modifications, then click "Next" until reaching the "Save" button at the end of the insurance configuration.

Editing the Rendering Provider for Claims

33. 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

Click Next until you reach the Save button at the end of the insurance configuration, and then click Save.

In the client's profile, it is necessary to designate the Case Lead Analyst for the case. If the option "The NPI of the Case Lead Analyst" is selected, this information will be transmitted to Billing accordingly.

Editing the Supervising Provider for Claims

34. Editing the Selected Option for Supervising Provider

  • Edit the selected option based on whether you want to send the Supervising Provider information.
  • Mark Yes or No.
  • Click Next until you reach the Save button at the end of the insurance configuration.
  • Click Save.

In the client's profile, you must select the Supervising Provider for the case. If the "Yes" option is selected, this information will be transmitted to Billing accordingly.

Add a new procedure

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

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

For combinations of procedure and modifier, the procedure and the modifier should be separated by a space.

Ex 97155 HN instead of 97155HN

37. Click "NEXT" to configure the service corresponding to the procedure.

Add more events

38. You can also add more events, just select Add Event

39. Select the Service

Assign the corresponding service to the code. 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.

40. 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.

41. 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.

You have to type only the amount, don't add the "/ 15 min" part

Add Modifiers

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

Please add only the optional modifiers that are not part of the prior authorization codes here. Staff members will be able to select these modifiers when creating a visit.

43. 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.