Setting up Insurance Companies for Electronic Submission

Before you can submit claims electronically, you must assign a five-digit payor ID number to the electronically capable insurance companies that will receive the claims. You can use the Update payor IDs option to match the insurance companies in your database with the appropriate payor ID numbers. You can also assign the numbers manually.

To submit claims electronically to insurance companies that do not accept electronic claims, you can use a clearinghouse. The clearinghouse prints and mails the claims to the insurance companies.

Some insurance companies require additional enrollment forms before they accept your electronic claims. These companies are marked with a plus sign (+) sign in the payor Pick List.

Some insurance companies require that your provider number be on file at your electronic services vendor location before they will accept your electronic claims. These companies are marked with ID in the payor Pick List.

You must receive written confirmation from these insurance companies before you submit electronic claims, without confirmation the claims will be rejected.

Assigning the Payor IDs Automatically

To match the electronic-capable insurance companies in your database with payor IDs from the PracticeWorks electronic services database:

From the Windows Start menu, select All Programs > CS PracticeWorks > Utilities. The PracticeWorks Utilities window is displayed.
Click the UPDATE PAYOR IDs button in the upper-right corner. The Modify Insurance Payor ID window is displayed.
If your database has never been set up for submission through the PracticeWorks electronic services clearinghouse, check both options to correct all insurance company payor IDs.
For those insurance companies that are not electronically capable, you can choose to have those claims sent as paper-electronic, which means they are submitted to the clearinghouse electronically, then printed and mailed. To do this, select SET UP ALL.
Click OK.

Assigning Payor ID Numbers Manually

To set up payor ID numbers manually:

From the Lists menu, select Insurance companies. The Insurance Company List is displayed.
Select the first insurance company in the list and click Edit. The Insurance Company Definition window is displayed.
Click Payor list. The Payor Pick List is displayed.
Scroll down and select the company that is displayed in the Insurance Company Definition window.
Click OK. A message prompts you to confirm the replacement of this number. Click Yes. The Payor ID field in the Insurance Company Definition window is populated with this number.
If the Insurance Company is a Blue Cross Blue Shield or Medicaid, click Ins. Provider ID. The Provider ID window is displayed.
For Blue Cross and Blue Shield companies, enter the Provider ID that has been assigned to the provider by each state Blue Cross or Blue Shield Company. If none has been assigned, enter the Tax ID. Do not include dashes or spaces. Click OK.
For a State Medicaid payor, enter the Provider ID assigned by the state Medicaid. Click OK.
Click OK.

Repeat these steps for all Blue Cross and Blue Shield and Medicaid payors in the database.

In the Payor Pick List, note the (+) or (ID) next to payor names. Contact a sales representative for help with enrollment and determining an ID number for each of these companies.

You must receive written confirmation from these insurance companies before you submit electronic claims. Without confirmation, the claims will be rejected.

Removing Payor ID Numbers

To remove the ID number from a payor, delete the number from the Payor ID field in the Insurance Company Definition window.