Insurance Company Fields:
Carrier nameName: Insurance Company name
Insurance code: Insurance Company alias name. All Blue Cross insurance carriers will have an alias of
BCBS. The alias is used on Box 11c of a HCFA 1500 to identify the ‘true’ insurance company
name. Your electronic clearinghouse may need you to use the same names as they use.
Add1- Phone: Standard address, city, state, zip and phone.
Contact: Usually blank, you may have a personal contact at this carrier.
HCFA FORMAT: Print insurance forms for this carrier. You decide to not print claims for certain carriers.
ELECTRONIC: This insurance carrier will accept claims electronically.
Insurance TYPE: The type will cause an ‘X’ to print in box 1 of the HCFA 1500 for either Medicare,Medicaid, Other etc.
FORMNAME: You may have a different form layout for this insurance carrier. The form name
must be entered on the Insurance Layout screen of the Maint menu. The default form name is
HCFA, for UB04’s the default form name is UB04.
PayorID: The insurance companies payer id number for electronic filing.
Receiver Type: The receiver type. See the online help for a list of receiver types.
Submitter Id: The electronic submitter id, you may leave this blank and use the default office
submitter id number. You may have a submitter id assigned by the carrier.
Notes: Notes/memo, free form field.
Expected Reimbursements Tab: This is an edit in place browse. Enter the CPT and amounts
expected to be paid by this carrier for the cpt code.
CPT: Cpt code, code must be valid.
Description: This field will be contain the description from the CPT code file.
Amount: Amount expected to be paid if this carrier is primary.
Tax id – Enter the default tax id
Pre authorization – If pre authorization required, activate this button.
