FAQs: Completing CMS 1500 form on Healthie
Our goal at Healthie is to make it easy for providers to create and submit insurance claims to streamline billing.
Here are some answers to commonly asked questions regarding insurance billing via the Healthie platform.
IN THIS ARTICLE:
- What insurance companies are compatible with Healthie's Insurance Billing Software?
- What Clearinghouses and insurance portals are compatible with Healthie's Insurance Billing Software?
- How can I add my biller to the platform?
- How can I create a CMS 1500 form for another provider in my organization?
- How do I submit a document (e.g., chart note, physician referral) to accompany a claim?
- Policy holder
- CPT and ICD-10 codes
- Default POS code
- ICD Ind field
- Policy address
- Diagnostic pointers
- Place of Service
- Add telehealth as a Service Facility
- Other ID Qualifier
- Add a Modifier
What insurance companies are compatible with Healthie's Insurance Billing Software?
Healthie's CMS 1500 platform is compatible with all insurance companies; the platform generates industry-standard forms. As a result, providers can submit claims to any insurance company using Healthie.
What Clearinghouses and insurance portals are compatible with Healthie's Insurance Billing Software?
Our providers use many Clearinghouses, commonly including Office Ally, Availity, and others. Many claims are also uploaded directly into insurance portals.
We currently include an auto-integration with Office Ally, and are planning to add additional Clearinghouses to our integrations list as well. Have an insurance clearinghouse you use, that you'd like Healthie to integrate with? Cast your vote here.
How can I add my biller to the platform?
How can I create a CMS 1500 form for another provider in my organization?
While completing your CMS 1500 form, adjust "Rendering Provider" within your organization.
How do I submit a document (e.g., chart note, physician referral) to accompany a claim?
The Name of the Policy Holder is the "Primary Holder" of the insurance account. Oftentimes this is the name of the patient that you are working with. Sometimes, however, it is a relative - in this instance, put down the name of the primary holder, and the relationship between the primary holder and the patient.
CPT and ICD-10 codes
CPT codes are the shortened form of Current Procedural Technology. CPT codes show what treatment you provided for your client. They include every type of service or procedure (tests, evaluations, etc.). The CPT codes that you include on your Superbill are the services your client could be reimbursed for. Common codes for nutritional care are 97802, 97803, and 97804.
ICD codes (or sometimes ICD-10) is shorthand for International Statistical Classification of Disease and Related Health Problems 10th Revision. ICD-10 is a clinical cataloguing system that assists in making a diagnosis. ICD-10 is the latest version of this code. (ICD-9 will likely be rejected because it is outdated). ICD-10 has been digitalized so that it now more accurately reflects our understanding of health problems today and includes a greater variety of classifications. ICD codes, simply put, represent the symptoms that your client is seeking to treat.
- Here is a link to all active ICD-10 codes (note: many are pre-loaded into Healthie)
If you need to include a CPT or ICD-10 code that is not pre-loaded into the Healthie system, message our live chat or contact us: firstname.lastname@example.org
Default POS code
If you update the POS code for a specific client, that will become the default code for that particular client (but, not for all clients).
ICD Ind field
The ICD Ind field denotes whether a diagnosis code is from the ICD-10 or ICD-9 set, and does not reflect the actual diagnosis entered. It may appear in a generated PDF as 9 or 0.
This is not a required field. Each Policy name has a designated code associated with it that auto-populates the address for you in the CMS-1500.
Diagnostic Pointers (Box 24e on the CMS 1500 form) are used to indicate the line letter from the diagnosis code, that relates to the reason the service(s) was performed. You can include up to 4 diagnostic pointers on each line. The first pointer designates the primary diagnosis for the service line. Remaining diagnosis pointers indicate declining level of importance to service line.
Place of Service
A Place of Service is a field used when completing a CMS 1500 form to submit a claim to insurance. It indicates the location in which the health care service is actually provided. The Place of Service (POS) is a two digit code used on Box #24B to indicate where services are rendered.
How to enter your Place of Service in Healthie
- Select "Place of Service" dropdown under "Service Facility"
- Select from the following options provided for your convenience: Office, Home, Place of employment / worksite, Telehealth, Home, Other
- Check with a client's insurance company as to their specific reimbursement policies for each POS
- The most common Places of Service are 11 (Office) and 02 (Telehealth
- Please review the CMS Guide on Place of Service for other best practices
Add telehealth as a Service Facility
- Adjust the Service Facility on your CMS 1500 in the "Service Facility" section
- Select "Add New Service Facility"
- Select "02 - Telehealth as Place of Service
Other ID Qualifier
Other ID Qualifier is an optional field that is used when you need to input another ID, if you do not use an NPI number in your work. If you have an NPI number, you can enter that in the "NPI field" and can leave Other ID Qualifier blank.
The qualifiers will indicate the non-NPI number being reported. The NUCC outlines that the following Other ID Qualifiers can be used:
"0B" - State License Number
"1B" - Blue Shield Provider Number
"1C" - Medicare Provider Number
"1D" - Medicaid Provider Number
"1G" - Provider UPIN Number
"1H" - CHAMPUS Identification Number
"EI" - Employer’s Identification Number
"G2" - Provider Commercial Number
"LU" - Location Number
"N5" - Provider Plan Network Identification Number
"SY" - Social Security Number (the social security number may not be used for Medicare)
"X5" - State Industrial Accident Provider Number
"ZZ" - Provider Taxonomy
Add a Modifier
Navigate to Misc Info > Modifications > Add Modifier > Create