In this article, read on to learn more about the top OptiMantra insurance and billing questions we receive:
TABLE OF CONTENTS
- Enrolling with Payers for EDI/ERA/EFT
- Calculating coinsurance
- Submitting Medicare claims with the date of injury for Chiropractors
- Printing claim (HCFA) data on an existing form
- Adding NDC codes
Enrolling with Payers for EDI/ERA/EFT
Please see the article Get started with insurance billing
Calculating coinsurance
OptiMantra's coinsurance feature allows you to calculate a client's out-of-pocket charge at check-out and charge different amounts for a service(s) - this is commonly used for Coinsurance situations, but can also be used for high-deductible plans
Please follow the steps below to set up and then use the coinsurance calculators
Setting Up Allowed Amounts
The first step is to set up the allowed amounts per Payer per Service:
In OptiMantra, go to Settings > Services & POS > Services (Fee Schedule) > More > Insurance Allowed Amounts
Click 'Add New Entry' and set the CPT Code, Payer ID and Allowed Amount
Note: the CPT Code needs to match the CPT on the Service selected on the chart note and the
Patient's Payer ID (from Primary Insurance) needs to match the Payer ID on the Allowed Amount setup
Adding Allowed Amounts to Superbills
When you create the new Superbill, you will have to either use - New Superbill, or New Superbill with Products only - to take advantage of allowed amounts
That way, the program will know which chart to look at - it will pull the CPTs with the allowed amounts as well as the Coinsurance from the patient's profile to populate the Superbill.
Submitting Medicare claims with the date of injury for Chiropractors
For Medicare claims with injury dates for Chiropractors, OptiMantra received specific instructions from Office Ally on how to populate claims
a. The 454 should be submitted in Field 15 with the Injury Date
b. Field 14 should remain blank
When Office Ally sees these fields, they determine that it is a Chiropractor's submission (apparently based on the Provider Enrollment with Medicare) and thereby will populate Field 14 from Field 15 information
This information can be input in either the New Initial Consult or the New Follow Up chart notes. This information is not available in the New Basic Note.
Printing claim (HCFA) data on an existing form
If you are trying to print the claim information in OptiMantra onto an existing claim form (red form), please follow this article: https://acrobatusers.com/tutorials/how-do-i-print-only-form-field-data
Note that you may have to download/save the claim on your desktop computer first and then open it with the Adobe (Standard or Pro edition) to complete the instructions
Adding NDC codes
For Office Ally submissions, the NDC information must be formatted in the following way:
Enter the values in this order: Qualifier Code, Charge, Per Unit, Units, then Measure, separated by spaces.
So, for example, one output would be: N4 12345678921 150.25 2 UN
Note: You will need to set up your J and Q codes as services in Settings > Services & POS > Services (Fee Schedule) for these items to transfer to your HCFA. You need to manually enter your NDC in the line above your DOS/code entry on the HCFA worksheet, which will then be transferred to the HCFA.