For the main information on how the 1500 form works in ClientTracker, read the ClientTracker Manual pages 35-40. This page gives further clarification on these issues:

1. Preventing Rejected Claims
2. Changes in the new 1500 to accommodate the NPI number
3. 1500 functions in ClientTracker
4. Credit or Refund Client or Insurance Overpayment

 

Preventing Rejected Claims from your Insurance Company
Before you submit a claim, it is helpful to do the following:

Initial set up for a client’s insurance

1. Call the insurance company and get clear on:
-- the terms of your client’s policy, what they will reimburse for, what are the co-pays, deductibles.
-- do they want Box 24 F to be a Unit or Multiple. See the ClientTracker Manual page 37-38 for details.
-- do they want Box 33b filled in with your state license number (default) or their number. If the latter, go to the insurance company’s record; enter both the qualifier and the number for Box 33B.
2. Enter all the insurance company information in their record
3. Create your client’s account with that insurance company, including box 11.
4. Record the client’s signed receipt of privacy practices in ClientTracker (from the Personal tab)

Creating the 1500 form

1. Fill in Box 10
2. Insure that your Diagnosis Code(s) in Box 21 are accurate.
3. Box 24—make sure Box 24 E is filled in for each line in 24. There should be no commas after each of the numbers.

Submitting Claims to Office Ally (electronic clearing house).

1. Double check each invoice that all the necessary fields are filled in before  submitting the batch file to Office Ally. Box 11 must be filled in. Box 33 must be the Practitioner’s name, not the Practice name.

2. The name of the Batch file MUST contain the word ClientTracker in the name--can be anywhere in the name, although first is suggested.

3. Save the file as a .tab file.  The manual incorrectly says to save as a .cvs file.  However the dialog box that comes up before the user gets the option to save the file correctly says to save it as a .tab file.  Once they create a file with that, future saves should come up with the .tab  automatically selected.

An Office Ally support technician may try to tell you to save it as another type of file: .txt, .cvs or .xls. These will not work. If you are having trouble with Office Ally accepting your claims, please email info@ginkgosoftware for support.

4.  Only send one batch a day to Office Ally.  One ClientTracker user reports that sending more than 75 invoices at a time can cause corruption.

5. You should receive an email from Office Ally acknowledging the batch.  If you don't receive an email from OA, they need to check that OA has the correct email address.

It will say all is well or that one or more 1500's have a problem.  You can go to your account in Office Ally and make the necessary changes there without having to resend them from ClientTracker.  The 1500 can be rejected for any number of reasons, missing data, wrong Diagnosis code(s) or wrong Procedure Codes.

Possible causes for rejection usually involve one of the above steps not being completed correctly. Please double-check that you have completed the above steps before contacting support.

Changes in the new 1500 to accommodate the NPI number

Box 17a & Box 17b (Optional)
If you have created the referring provider and entered his or her NPI and license number these automatically fill in as follows:
17a License #
17b NPI #

Create the referring provider from one of the following:
1. Client's Personal Tab: in the second column, bottom area, Referred By; click on the Edit List.
2. Settings/Practice tab: click on the Physician List button at the bottom center of the screen.

32a Facility NPI: fills in automatically from the Facility NPI field on the Settings/Practice screen

32b: Optional. The odds of this needing to be filled are very rare. However, if you do, you can enter what you want directly in that field. Once you entered it for a client, it will automatically fill in the next 1500 created for that client.

Box 33
While ClientTracker is set up to have either the Practitioner or the Practice name here, the best practice is to have the Practitioner’s name.

Office Ally: you must have your Practitioner name here for the 1500 claim to be processed correctly.

Box 33 Address
There are two addresses that can show in area 33 on the CMS 1500 form. You can choose which one to show by clicking the 'Toggle Address' button just to the right of box 33 on the CMS 1500 form. The addresses that you are selecting are:

1. The practice address - this is set in Settings>Practice
2. The practitioner's address - this is set in Settings > Practice as well. If only one practitioner is showing, click the 'Show Details' button under their suffix (credentials). If more than one are entered, click the blue arrow button to the left of their name. This enables you to change the practitioner's information, including address.

33a Provider NPI: required, automatically fills from the Practitioner's NPI

Box 33b
1. By default when nothing is filled in on the insurance company record, the data for Box 33b is pulled from the Practitioner's license # which is stored in the Practitioner's record. ClientTracker automatically puts a 0B in front of the license # as required. If 33b is coming up with just the 0B, have you filled in the Practitioner's license # ?

2. Some Blue Cross and Blue Shield may require their Pin # to show up in Box 33b. This can be set up automatically by going to their insurance company record. In the bottom of the CMS 1500 box that contains info specific to each insurance company, put the Pin # and the Qualifiers. Notice the specific list for the qualifiers. When the insurance company has this filled in, then this is the first default for Box 33b.

Here are the two digit qualifiers that precede of the respective pin numbers:
1A Blue Cross Provider Number
1B Blue Shield Provider Number

Office Ally: they automatically pull the number from 33b and insert it in Box 24J in the pink shaded section above the NPI number.

To have the 1500 print with the shaded pink area of Box 24I & J filled in, contact ClientTracker tech support.

3. You can also enter specific data in this. Once you entered it for a client, it will automatically fill in the next 1500 created for that client.

1500 Functions in ClientTracker

ClientTracker’s Default Tab Navigation
If you use the Tab button on your keyboard, it takes you to Box 21 to enter the Diagnosis Code. Continued tabbing takes you to the rest of the Diagnosis Code boxes, then on to each line of the frequently used Boxes for 24.

The tab doesn’t start with Box 1a or Box 2 because the data in the 1500 is filled in automatically from other sources in ClientTracker (Boxes 1-8, Box 11-13 and Box 10 needs to be clicked in--you can’t tab into a checkbox).

Multiple visits per 1500
The 1500 allows for 6 Procedures per form in 6 lines in Box 24. It can be used for one date (or visit), with all the procedure codes being that one date. Or it could have up to six visits if each visit had only one procedure code, or 3 visits with 2 procedures per date, or any combination. It is your choice.

Products on the 1500
Most insurance companies do not reimburse for products or herbs. If they do, they will want a specific Procedure Code.

If herbs are sold on the same visit(s) in Box 24, you have a choice of either creating a new Simple invoice for the sale of herbs or putting them on the Other Details tab. We recommend the former as it keeps the payments very clear.

Co-pay & Third Party Payer
This was created to clearly track and report on what is expected and paid from the insurance company versus the client.

The Third Party Payer is set to Yes when a CMS-1500 is created. It is set to No when a Superbill or Simple invoice is created. You can change that on either the 1500 or Superbill. (The Third Party Payer feature was designed for when you expect money in from an insurance company, and therefore would most likely be used on the CMS-1500.)

Go to the Other Details tab of the 1500 to see the full Third Party Payer? area. The Total Expected and Due from 3rd Party is automatically set to the total of Procedures. You can manually adjust this figure: Click in the Total Expected field and enter the amount of the procedures less the co-pay. Or this adjustment can happen semi-automatically:
Create a New Payment; set the Source to Co-pay; fill in the Method, Amount, and any other desired Payment fields. Click the Apply button and a dialog box pop-ups:
"This payment from the client is for more than is expected.
Adjust the "expected from third party" accordingly?
Or adjust the payment amount?"
Choose Expected. This will now change the Total Expected and Due from 3rd Party to the amount of the procedures less the co-pay.
Choosing Payment will adjust the payment Amount you are creating.

The Transaction report in the Detail view shows what is Due from the Client and from the Third Party. Both the Detail and Summary views show the grand total due from Client and from the Third Party.

Showing the Co-pay in the 1500 form:
Box 29 is the place to show any patient payments on a 1500. Most insurance companies don't want to see a number in this box; however, you have several choices as to what would show here.

At the bottom of the 1500 is a light blue area. Setting your preference here for how Box 29 works for the current invoice only. You can show $0, any co-pays the patient may have paid on this invoice, all payments paid on this invoice, or you can type in any amount you like (Custom).

Credit or Refund Client or Insurance Overpayment
The following will give several options:
-- Crediting or refunding a client's overpayment
-- Refunding an insurance company's overpayment
The following is detailed to accommodate various possibilities.

Credit or Refund a Client’s Overpayment
Usually happens on a 1500 invoice when the client overpays their co-pay.

Fictional Case
A 1500 is created with $150 in procedures.
The Third Party Total Expected is automatically set to $150.
Client pays $30 and the Total Expected is adjusted to $120.
A payment is attempted using an Insurance check for $130.

Oops—ClientTracker will not accept the $130 because is shows the due amount as $120. At this point you have two options: I. Issue a credit to the client, or II Issue a refund to the client (in this example: $10)

I. Issue a Credit to the Client

Correct the Client Payment & Give Client Credit
1. Go to the invoice 1500, click on the Other Details tab; scroll down to see the Payments.

2. Write down the invoice #, the correct amount of the client payment (for this case $20) and the client’s overpayment information: date, method, amount, etc.

3. Delete this payment using the trashcan icon

4. Click on the Payments on Account button and go to the client’s Payments on Account area.

5. Enter a New Payment using the data noted in step 2 above.

6. Locate the invoice, enter the payment in the Enter Allocated Payment column (in this case $20), and click Distribute button.

The above steps 4-6 effectively recreate the payment as a payment on account so that part of it can be allocated to an invoice, and part (in this case $10) remains as a credit that can be applied to other invoices.

Adjust Third Party Payer Expected & Applying Insurance Payment
1. Return to the 1500 to pay the insurance by clicking on the invoice number
2. Click on the Other Details tab

If no insurance payment has been made yet:
3. Go to the Third Party Payer area at the top of the invoice

4. Click in the Total Expected, and change the amount to the actual payment, (in this case $130).

5. Create a new payment for the insurance company (in this case $130). Or if the check is for many invoices, click on the Insurance Payment button and pay the invoice from there.

If an insurance payment has been made and was mistakenly put in for the lesser amount (in this case the check was for $130 and $120 was entered):
3. Scroll down to see the Payments area

4. Write down the insurance payment information.

5. Delete this insurance payment using the trashcan icon

6. Go to the Third Party Payer area at the top of the invoice

7. Click in the Total Expected box, and change the amount to the actual payment, (in this case $130).

8. In the Payments area, create a new payment for the insurance company for $130. Or, if the check is for many invoices, click on the Insurance Payment button and pay the invoice from there.

If an insurance payment has been made and an additional check comes in (in this case $10):
3. Go to the Third Party Payer area at the top of the invoice

4. Click in the Total Expected box and change the amount to the actual new payment (in this case $10).

5. Click the Other Details tab and create a new payment from the insurance company for the amount of the new check (in this case $10). Or if the check is for many invoices, click on the Insurance Payment button and pay the invoice from there.

II. Issue a Refund to Client

Correct the Client Payment & Refund the Client
1. Go to the 1500 invoice, click on the Other Details tab; scroll down to see the Payments.

2. Create a new payment for the client in the amount of the overpayment; make it a minus number (in this case -$10). We suggest using the same Source that the original client overpayment has. However you may want to check with your accountant as to what to use for:

Source: Client, Co-Pay, or Adjustment.
Method: Check, Cash, any credit card.
Note REFUND or your choice of info.

3. Give the client a check or credit card refund to match the above entry.

Adjust Third Party Payer Expected & Applying Insurance Payment
1. Return to the 1500 to pay the insurance by clicking on the invoice number
2. Click on the Other Details tab

If no insurance payment has been made yet:
3. Go to the Third Party Payer area at the top of the invoice

4. Click in the Total Expected, and change the amount to the actual payment, (in this case $130).

5. Create a new payment for the insurance company (in this case $130). Or if the check is for many invoices, click on the Insurance Payment button and pay the invoice from there.

If an insurance payment has been made and was mistakenly put in for the lesser amount (in this case the check was for $130 and $120 was entered):
3. Scroll down to see the Payments area

4. Write down the insurance payment information.

5. Delete this insurance payment using the trashcan icon

6. Go to the Third Party Payer area at the top of the invoice

7. Click in the Total Expected box, and change the amount to the actual payment, (in this case $130).

8. In the Payments area, create a new payment for the insurance company for $130. Or, if the check is for many invoices, click on the Insurance Payment button and pay the invoice from there.

If an insurance payment has been made and an additional check comes in (in this case $10):
3. Go to the Third Party Payer area at the top of the invoice

4. Click in the Total Expected box and change the amount to the actual new payment (in this case $10).

5. Click the Other Details tab and create a new payment from the insurance company for the amount of the new check (in this case $10). Or if the check is for many invoices, click on the Insurance Payment button and pay the invoice from there.

The Payment Log will now reflect the negative payment as a CR and adjust the Paid on Invoice total to accurately reflect the income as less the refund.

Refund an Insurance Company Overpayment
This is a similar process as creating a refund for a client.

Adjust the Insurance Payment & Refund the Insurance Company
1. Go to the invoice 1500, click on the Other Details tab; scroll down to see the Payments.

2. Create a new payment for the insurance company in the amount of the overpayment; make it a minus number. We suggest that you use the same Source that the original Insurance overpayment has. However you may want to check with your accountant as to what to use for:

Source: Insurance or Adjustment.
Method: Check, Cash, any credit card.
Note REFUND or your choice of info.

3. Send a check to the insurance company for the check.

Adjust Third Party Payer Expected so the invoice balance is $0
1. Go to the Third Party Payer area at the top of the invoice
2. Click in the Total Expected; change the amount to the overpayment.

This information is provided as courtest for the convenience of our customers. If you are aware of any inconsistencies or errors in any information provided here, please let us know.