When you start to use TotalMD, you will need to set up all of the insurance plans that you intend to bill. Here is the link to a YouTube video and below are the instructions.
To add a payor to your TotalMD program, you will first go to Lists>Insurance Plan List:
You will then see any Insurance Plans you have already entered listed there:
As you can see, you may have more than one entry per payor, depending on your patients and your providers.
To add a new payor, you will go to New Insurance Plan to the left:
You will then add the Insurance Name, Address, City, State and ZIP Code:
On the left-hand side of the top section, you may need some help from your enrollment specialist to fill this out. You will want to choose your Fee Schedule, Enter the Payer ID and Eligibility ID if you are going to be checking Eligibility, the type of insurance and check the Send Electronic Claims box. The Module will need to be chosen correctly as well.
You will want to consult with either your trainer or your support specialist at TotalMD to make sure the middle section is filled in correctly. These choices determine information that is found on the 1500 form:
The information that goes into Box 33 is the entity that is paid by this insurance company. If the group is reimbursed by this payor, you will want the Practice Information. If the provider themselves is reimbursed by this insurance, you will want the Individual Information in this slot.
In Box 24J, the Individual NPI needs to be placed here as an entity cannot be billed in this slot. For Box 25, you will want the TIN if Box 33 is the Practice, or the SSN if Box 33 is an Individual NPI.
Box 33A will correspond with the answer in Box 33 – either the individual or the group.
At this time, all insurances accept ICD-10, so that box is not necessary. The Diagnosis Code Set and the Procedure Code Set is normally set to Base. If it needs to be changed, you will want to discuss this with your support representative.
If this is a code for something that will not be billed to either the Insurance or the Patient, you can check those boxes as necessary.
The final section determines what you see in the Payment Screen. The first choice is how you get paid by this insurance company – is it paper check or EFT?
The two Default Adjustment Code selections allow you to default the first two Adjustments on the payment screen to four different choices:
The final choice will all you to add a default Takeback Code – if you have created one in the system:
You will then Save Changes to the left:
This will bring you back to the Insurance Plan List screen, where you will see your new Insurance Plan:
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.