Medisoft's Flexible Grid
New Flexible Grids for Claim Generation
NOTE: Before sending claims, you will need to finalize your practice and provider setup information on the IDs grids. If you are upgrading to Medisoft 16, you will also need to finalize your IDs grid information. To provide the highest level of data integrity and accuracy, the conversion process for Medisoft 16 provider/practice setup, does not delete information while creating grid entries that might still be needed, such as legacy information (Blue Cross provider numbers, Medicare provider numbers, etc.) but converts this data to a grid entry in Medisoft 16. Before filing claims, you will also need to finalize your grid entries making sure to remove unnecessary data such as out-of-date legacy numbers. For more information, see Medisoft Claim Generation FAQ
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Medisoft 16 introduces new user interface windows to better address different insurance filing requirements. This new layout gives you the flexibility to easily configure your setup to address various requirements when generating both print and electronic claims.
The new implementation provides a flexible environment that you can quickly customize to reflect your claim processing needs by setting up different gird entries for insurance carriers, providers, your practice, or your data requirements (NPI, legacy, etc.) that you can apply and, if needed, quickly modify. These changes support creating as many custom scenarios that you need to successfully file claims.
This new method streamlines and consolidates tabs on key windows such as the Insurance Carrier, Provider, and Referring Provider and moves labs and facilities from the Address tab to the Facility tab. Also, the Practice Information window features a new tab, Statement Pay-To, which is used for Bill Flash reports.
The key element of this improvement is the implementation of Practice, Provider, Referring Provider, and Facility IDs grids. The settings and selections that you make on these grids, along with settings on the Insurance Carrier window, are used for claim generation. These settings are highly flexible, providing greater breadth and depth to address your particular office’s billing needs. The inherent flexibility in this implementation means that you can enter limitless scenarios for any combination of insurance carriers, insurance classes, facilities, referring providers, providers, and your practice to address different carrier filing requirements.
Another important change for electronic claims involves the logic of group and individual filing moving from the EDI Receivers window to the Provider window. You now bundle claims by creating provider filing rules using the Group or Individual buttons on the Provider IDs grid instead of sending via a group EDI receiver or an individual EDI receiver; however, if a carrier requires further refinement, you can create/use multiple submitter IDs to separately batch by submitter ID.
NOTE: Any custom report, either created or modified, in a version of Medisoft prior to 16, such as the CMS 1500, will not pull some data if the field in question was impacted by the new fields on the various IDs grids. The level of customization that went into creating the original report will determine if you should modify the report to reflect the new fields in Medisoft 16 or re-create your custom CMS 1500 form using the CMS 1500 form included with Medisoft 16. For more information on where fields now pull for printed claims using the CMS 1500 form, see Clickable CMS 1500
. For more information on the new logic for the changed fields in the CMS 1500 reports, see the topic CMS 1500 Report Changes with Medisoft 16
. The UB-04 form was also modified. For more information on where fields now pull for printed claims using the CMS 1500, see Clickable UB-04 Form
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NOTE: Statements in Medisoft 16 do not pull data from the EDI PINS table. If you customize these reports, you cannot add this data to a statement. This data, however, is available when customizing claims, such as the CMS 1500 form, and all other reports. If you have statements from pre-Medisoft 16 that you added these fields to, the statements when used in Medisoft 16 will leave the fields blank.
