From the Home screen of TotalMD go to Lists>Insurance Plan List:
You will then see a list of any insurance companies you have in your system:
You can then Edit Insurance Plan to the left, click F9, or simply double-click on the insurance plan you wish to edit:
You will then see the Insurance Plan screen:
You will want to verify the street address information that is there and check it with the green check mark for correctness. The next step you will want to take is add the Fee Schedule that is associated with this Payer:
You will then verify their Payer and Eligibility IDs. They may be the same, depending on the clearinghouse that you are using to send electronic claims:
Then, the Insurance Type will need to be chosen:
You will also want to make sure Eligibility and Electronic Claims are both checked, if you intend to use these features within TotalMD:
Then the choice for what typically goes into Box 33 on the CMS 1500 needs to be chosen, whether the provider or the practice receives payment from this payer:
Then the type of Provider Identifier needs to be added:
The NPI for Box 24J (Rendering Provider) and 33A (Billing Provider) need to be added:
The Diagnosis Code Set and the Procedure Code Set needs to be chosen if you have more than one set in your system:
You can also choose to not bill for a particular insurance or not to bill the patient for a particular insurance:
You can choose the default payment type for this particular insurance, if they are paying EFT (electronic funds transfer) or by paper check:
Then Adjustment and Takeback Codes can be defaulted as well:
Under the Contract Allowed tab, you can enter contractually allowed amounts for this insurance company:
Under the Pins tab, you can a pin for any provider already set up in the practice, if necessary:
Adding a new insurance company is similar, first go to New Insurance on the left or type F8:
Once you have the Insurance Plan screen open you will want to fill the following fields in the top of the screen:
In the middle section, you will want to make choices in these fields:
In the bottom section, you will want to do the drop down choices for the ERA information:
In the bottom of both a new and revised Payer, you can make notes about that payer such as:
You will then Save Changes or type F3:
You then have a new Payer in your List:
You may then want to go back into the Payer and add Contract Allowed Amounts, if you are aware of these amounts:
You will want to go to the Pins tab to add any appropriate information and to make sure SOF (Signature on File) is checked for each provider and Accept has an “A” if your provider accepts assignment from this payer:
If you have questions regarding this functionality of TotalMD, please contact our support or training departments at 800-613-7597 Option 2 for Support or Option 3 for Training. If you would like a printable copy of this article, please contact Training at Option 3.