Each insurance carrier has its own unique requirements for this box. Make your selection from the drop down box accordingly.
•Duplicate Insured Information will copy the information from boxes 4 and 7
•Leave Information Blank does not print anything in box 9
•Custom opens a text box allowing the entry of whatever standard information this insurance carrier requires in box 9. Note that this will appear on all claims for this insurance carrier
NOTE: some insurance companies are now requesting that box 9 be used for patient specific information. For this reason, in the Patient Insurance Policy window, there is now an option to enter text for box 9 that will appear for only that patient. Data entered in the Patient Insurance Policy box 9 text box overrides the selections made on this window.
DX Relation (Box 24E)
In order to maximize collections from insurance carriers it is necessary to do diagnosis pointing. In this section, the program is being told how to connect a diagnosis with the services or products being billed on the CMS-1500. Diagnosis Pointing bundles or separates the services provided by diagnosis. The impact is that if all services are bundled, then insurance companies pay the least. For example, if chiropractic adjustments and physical therapy are performed on the same date, and everything is bundled by pointing all ICD codes to all the services, then the carrier will look to see which service has the lowest payment scale or least number of allowable visits. Regrettably, the lowest paying service is frequently spinal manipulation, restricting care to only 4 to 8 visits per year. If diagnosis pointing is used and the physical therapy items are separated by diagnosis from the spinal manipulation, although the adjustments will still be cut off at the imposed cap, the physical therapy charges may continue to be paid under the physical therapy benefit, which could be up to 75 visits for the year. This will vary greatly by insurance carrier and policies, but could increase the retention of patients, your patient visit averages, and your income.
Six options are available for Diagnosis Pointing in the insurance catalog. Note that different options can be selected for each insurance carrier. The choices are:
•1, 2, 3, 4 (Ignore DX Count) is now rarely used. This entry places the numbers 1, 2, 3, 4 on each line of entry in box 24 E, regardless of how many diagnoses are actually in box 21. If you have fewer that 4 ICD codes but the pointers show 4, claims will be rejected. This option eliminates any potential benefit from performing Diagnosis Pointing.
•Custom allows the entry of any one or more of the numbers 1, 2, 3, 4. For example, if this insurance carrier requires that only one diagnosis is permitted, and it must be diagnosis #1, then placing the number 1 in the custom box causes each line of box 24E to contain ONLY 1. After selecting Custom simply type the entry in the custom box.
•Use ICD Code from DX 1 has become obsolete and should not be used. The rules for using the CMS-1500 require that only the numbers 1, 2, 3, 4 be used in box 24 E. In the old HCFA-1500 form that was used many years ago, there was the option to allow the ICD code to be printed in this box. At this time, an ICD code in this box will trigger a rejection of the claim.
•1, 2, … (Use actual DX count) is the most common selection. On each line of box 24 E, the appropriate numbers will be printed based on the actual diagnoses listed in box 21. However, this is not true Diagnosis Pointing and still bundles all services with all the diagnoses.
•Use SmartPointerAI Rules is for true Diagnosis Pointing. When this option is selected, a button appears to View SmartPointerAI Rules. Click the button to create, edit, or delete the rules. Once the rules are set up, then the system will automatically enter the Diagnosis Pointer for each line item service listed in box 24 of the CMS-1500.
•Print Without Commas has become obsolete. It no longer has any effect. On the old HCFA-1500 form, some insurance carriers wanted the Diagnosis Relationships to appear differently (with commas, without commas, with spaces, without spaces). However, for the current CMS-1500 the rules were changed so that any numbers that print will NOT have commas or spaces.
Additional options are in the ChiroOffice section of ChiroSuiteEHR for Diagnosis Pointing. The additional options are on the transaction window and in the Settings. These additional options will be described in greater detail in the sections of this manual for the Transaction Window and system Settings.
•On the Transaction Window, very specific diagnosis pointing is done in the the DX Rel column. An entry in that column overrides the selections made in the insurance carrier CMS tab.
•Go to Tools > Settings. Select the Transaction icon and choose the SmartPointer options at the bottom of the window.
Tax ID Type (Box 25)
In order to get paid by insurance, you must provide your tax identification number. Although the option is present to use your social security number, Life Systems Software strongly recommends that the Federal Employer Tax ID number should always be used. It is much more difficult for identity thieves to steal identity from an Employer ID number than from a social security number. Click the dot next to whichever number you are using. ChiroOffice will pull the selected number directly from the Provider catalog.
ID Number/Group (Boxes 24I, 24J, 32b, 33b)
From the Provider catalog, ChiroOffice creates a list of the providers of service in your office. Within each Insurance Carrier catalog, for each provider, there is the option of entering the legacy ID number issued by the insurance company, a group number and a qualifier for the legacy ID number. If entered, these numbers may appear in the shaded areas of boxes 24J, 32b, and 33b. The appearance of the numbers in the appropriate boxes is set and determined by the entry made on the Claim Options tab. The qualifier is shown in the shaded areas of box 24I. To enter a qualifier, click on the drop down arrow and select the appropriate item. The qualifiers were established under Federal rules. At this time, the only qualifiers available are the ones on the selection list.
NOTE: The rules about using these identification numbers are not the same for each insurance company. Be sure that you know what each insurance company requires prior to making your selections. For example, Medicare requires that the shaded areas are blank and should never be filled in when an NPI is entered.
Insert Placeholders and Reserved for Local Use (Box 19)
These 2 boxes work together. The Insert Placeholders box is the selection list for patient specific items that will appear in box 19 for this insurance carrier. Reserved for Local Use (Box 19) displays the items chosen. The selection list includes items that are patient specific, although a global option can also be entered:
•Nature of Illness – This is an old Medicare requirement to denote the patient’s status such as Acute, Chronic, Recurrence, etc. It is usually not required. The nature of illness is now shown to Medicare by the use of the AT modifier, for Active Treatment.
•Subluxation Level –
o Always select this item. It turns on the text function in the patient file for box 19. If no entry is made in the patient file, it will leave box 19 blank. If this item is not selected, then data entered in the text field in the patient file will not generate into the claim.
o In the past Medicare required identification of a specific subluxation level. This is no longer needed for Medicare in box 19. The specification of subluxation level(s) must be in the SOAP notes.
o If you treat Medicaid patients, there are certain explanatory codes that must appear in box 19, such as Y- Pregnant. In order to enter such codes in box 19, select Subluxation Level so it appears in Reserved for Local Use (Box 19). In the patient’s Insurance Policy CMS tab, type the Medicaid explanation code in the Subluxation box.
•Treatment Number - In the past Medicare required knowing how many visits the patient has had. This is no longer needed for Medicare in box 19. If Medicare changes the rules again, this option remains functional.
•X-Ray Date – Another Medicare requirement is to show the date of the most recent x-ray which substantiates the need for care (the subluxation). This is required if the PART exam documentation is not being used to demonstrate the need for treatment.
•Exam Code
•Diagnosis 1-4 – These are the 4 primary diagnoses and usually appear in box 21. There are some insurance carriers that want the ICD diagnosis codes to be in box 19. This selection will move the ICD codes out of box 21 and into box 19.
•Diagnosis 5-8 – When you have entered more than 4 diagnoses on a patient, and want them to appear on the CMS-1500, some insurance carriers want any ICD codes in excess of 4 to appear in box 19 and not in box 21. ChiroSuiteEHR allows up to 12 active ICD codes to be present in a patient file. This option only refers to diagnosis codes 5 to 8.
•Diagnosis 9-12 - When you have entered more than 8 diagnoses on a patient, and want them to appear on the CMS-1500, some insurance carriers want any ICD codes in excess of 8 to appear in box 19 and not in box 21. ChiroSuiteEHR allows up to 12 active ICD codes to be present in a patient file. This option only refers to diagnosis codes 9 to 12.
•Diagnosis 1-12 – This option prints all 12 ICD diagnosis codes in box 19.
•Demo45 Date Last Seen – This option was included for the Medicare Demonstration Project and no longer applies.
•Demo45 UPIN 17a– This option was included for the Medicare Demonstration Project and no longer applies.
•Provider Taxonomy is a number issued in many states for special programs. It is used mostly by Medicaid, but not in all states. If you have a Provider Taxonomy number, it is entered in the Provider catalog.
•Clinic Taxonomy is a number issued in many states for special programs. It is used mostly by Medicaid, but not in all states. If you have a Clinic Taxonomy number, it is entered in the Provider catalog.
•Service Facility Taxonomy is a number issued in many states for special programs. It is used mostly by Medicaid, but not in all states. If you have a Service Facility Taxonomy number, it is entered in the Service Facility tab of the Provider catalog.
•Global Entry Option – In the event that there is something that needs to be in box 19 for every patient covered by this individual insurance carrier, and it will be identical for all patients, then type it into the box labeled Reserved for Local Use (Box 19). Once entered here, it will be print in box 19 for all patients covered by this insurance carrier. It applies 100% of the time.