Set Up Insurance Companies You Work With On Ambiki

Billing Guide
Set Up Insurance Companies You Work With On Ambiki image
Last updated: November 26, 2024
EMR Billing
Steps:

  1. Before setting up insurance companies, set up your Provider Info and Service Rates . If you have already done this, you can skip to step 2
  • Go to Billing in the navigation.
  • Click Provider Info and Service Rates. 
  • Enter all required information about your business. This information is included in the claim file sent to insurance.
  • Add the service rates for all services your clinic provides.



2. Set up Insurance company data for those payers you will be submitting electronic claims.
  • Go to Billing in the navigation.
  • Click Insurance companies.
  • Click New insurance company.

Enter all required information fields about the insurance company. This information is included in the claim file sent to insurance. If you are submitting claims electronically, your EDI Payer ID MUST be included, or it will be denied during the payer approval process.

Please also be sure to select an option regarding authorizations. You can choose from authorizations required, required for primary claims only, and not required. Optionally, you can choose to exclude evaluation events from the authorization requirement.

authorization settings



About Claim Filing Indicators
When submitting electronic claims, each payer has specific requirements for the insurance type to be indicated on claim forms. This requirement is noted by a claim filing indicator.

Common Claim Filing Indicators:
  • BL: Most BlueCross / BlueShield plans
  • MC: Most Medicaid insurances
  • CI: Most Commercial/Group health plans

Less Common Indicators:
  • FI: Federal Employees Program
  • HM: Health Maintenance Organization (HMO)
  • MB: Medicare Part B
  • ZZ: Mutually Defined (used when the insurance plan type is unknown)

There are many more types of uncommon indicators as well.

Please contact your payer if you have any questions about your insurance plan type, to determine the most appropriate claim filing indicator for your plan.



3. Set up Service Rates for Insurance Payers (Optional)
  • This step is optional, but can be helpful. If you do not include insurance-specific service rates, it will default to your provider service rates.
  • Similar to how you created your default service rates, you can create insurance-specific rates, including the rate your practice charges ("rate") and the contracted rate you expect to receive payment for from insurance ("allowed amount").
  • Similar to anywhere on Ambiki, Pay Rates can also be set up when creating your Service Rates if you use the organization payroll feature.



4. Click and Submit for Approval
  • Before being able to electronically submit claims for this insurance company on Ambiki, you will need to request approval. Ambiki staff will verify the data entered and finalize configuration. 
  • To request approval, open the Insurance Company and click Request approval.
  • The insurance company page will show an approval badge once approved.




Information on Insurance Payer Approval Process
  • Please note, in most cases, for commercial payers, electronic claim submission can be enabled quickly. However, many/most Medicaid and Medicare payers require an enrollment process prior to being able to submit electronic claims through an EMR platform. If this is the case, our enrollment team will reach out to you directly to complete the necessary documentation. These enrollment processes can take 60-90 days due to payer processing time, something that is unfortunately out of Ambiki's control. Our team will work with you to ensure correct and complete documentation so the enrollment process can be completed as quickly as possible. 
  • For ERA enrollment, as per best practice, Ambiki's enrollment team waits until the first claim is sent electronically through the EMR prior to initiating the process of ERA enrollment. Our team will reach out for ERA enrollment processes when appropriate. If you think you are missing an ERA or are expecting to see an ERA in Ambiki, please open a support ticket and our enrollment team will assist you. 



Once you have completed these steps, you can add the insurance company as a billable party on the payment method on the patient’s profile. You cannot add an Insurance Company as a payment method on a patient's profile if you have not completed the steps above. You do not need to wait for approval to begin adding payment methods to patient's profiles. 


How to edit default service rates and specific insurance service rates: https://ambiki.com/help/faqs/how-to-edit-default-service-rates-specific-insurance-service-rates