Make sure your Payors database includes all the payors you accept, with all their details entered correctly to keep billing running smoothly.

Here's a list of the items we recommend double-checking:

☞ Have you entered the correct Payor IDs?

• If you’re switching clearinghouses, update your Payor IDs to match your new clearinghouse’s list for all electronic payors.
• View TriZetto's Payor ID list in your portal under Resources > Payer List.
• View InfinEDI's Payor ID list here

☞ Have you indicated the correct payor settings?

• Most payors will be marked as Billable, meaning a claim will be generated and the payor is expected to process and adjudicate it.
  • If Billable is not checked, the payor will be considered non-billable. This would be appropriate for non-billable payors such as CHUSA (ChiroHealthUSA).
• Check Electronic Billing if you will be sending electronic claims to this payor. 
  • If Electronic Billing is not set, then all claims will generate as paper by default. 
• Check Sends to Secondary if the payor is a primary that forwards to a secondary. When enabled, ChiroUp will automatically move secondary claims from “Waiting on Other” to “Submitted” once the upstream payor ERA is posted.
  •  If Sends to Secondary is not checked, ChiroUp will move secondary claims from “Waiting on Other” to “Pending” when the upstream payor ERA is posted.
• Check In Network to label the payor as being In Network. 
  • If In Network is not checked, then you can enable Courtesy Billing on related purchases.
• Check Internally Billed to label the payor as internally billed. This is useful for clinics using third-party billing companies. Internally billed payors can be excluded from revenue calculations in the Compensation Calculator report.

☞ Have you planned for how you will manage Cash patients?

• Each clinic will manage cash patients a bit differently, however, we recommend adding Cash as a non-billable payor. Then, you can add your cash rates for each service code as ‘allowed amounts’ in your Payors database. Learn more about non-billable payors here. 

Make sure you've populated your Billing codes database with the service codes you most commonly bill (including the billed amounts, default modifiers, and payor-specific allowed amounts and modifiers). 

Here's a list of the items we recommend double-checking:

☞ Have you entered allowed amounts? 

• Entering allowed amounts isn’t required, but it helps estimate patient responsibility at check-out. For example, if a patient hasn’t met their deductible, ChiroUp will use the allowed amounts to calculate what they owe. Add the amounts you know in your Billing Codes database to make later billing — from collecting payments to posting ERAs — smoother.

☞ Have you entered your default modifiers?

• Set default modifiers for each service code. You can choose a general modifier that always appears when billing the code, or a payor-specific modifier that only shows up for certain payor policies. You always add or remove modifiers on the fly, but setting defaults helps speed up billing and keeps your claims accurate. 

☞ Have you entered any custom codes?

• ChiroUp is connected to the CPT service code library, so you can quickly search and link CPT codes to your database. For any other codes you may bill — like HCPCS or custom codes for cash-only services — be sure to add them as custom billing codes. 

Make sure you've entered the correct information in your billing profile(s). The information in your Billing Profile will populate Box 33 on the claim form. 

☞ Have you confirmed your billing NPI & Tax ID?

• The number one issue clinics face after going live is incorrectly entering billing profile information, which can lead to rejected claims and collection delays.
• Make sure your Billing NPI and Tax ID are correctly entered in your billing profile — this should be the NPI and Tax ID under which you are enrolled with the payor. We recommend double-checking your Billing NPI against your enrollments to ensure accuracy.
• Some clinics are enrolled with different NPIs (individual vs. organizational) for different payors — make sure you’ve created all necessary billing profiles in ChiroUp.
• Your Billing Profile information will populate Box 33 on the claim form.

☞ Have you connected your clearinghouse to ChiroUp?

• If you are using an integrated clearinghouse (TriZetto or InfinEDI) with ChiroUp, you'll need to connect your clearinghouse to ChiroUp by entering your Site ID and SFTP Password. Your clearinghouse rep will provide you with this information. 
• If you are using any non-integrated clearinghouse, you'll still need connect your clearinghouse to ChiroUp by selecting your clearinghouse name in the billing profile(s) and entering your Site ID/Site Tax ID/Acct Number for your clearinghouse. This ensures your claims are formatted correctly according to your clearinghouse requirements.

☞ Do you have to add a new billing profile after initial set up?

• ChiroUp will activate the clearinghouse integration for each billing profile. Your onboarding coach will ensure this is set up after you complete your checklist. If you ever need to add an additional billing profile later, be sure to let us know so we can activate the integration - or else claims will not send! 

Make sure you've entered the correct Provider billing information. 

☞ Have you assigned your default billing profile?

• It’s important to assign a default billing profile so it automatically populates on your purchases — and, in turn, on your claims.
  • If you don’t assign a default billing profile, you’ll need to manually add the billing profile to each purchase before a claim can be generated.

☞ Did you enter your rendering (Type 1) NPI? 

• The NPI you enter here will populate box 24j on the claim form. This should be your rendering individual NPI. 

☞ Do any providers at your office require supervision?

• If any providers in your office have a supervising provider sign their notes, enable Encounter Supervision. The assigned supervising provider will then sign off on those notes.
• If any providers bill under a supervising provider, enable Billing Supervision. The supervising provider’s billing information will automatically populate on the claim form.