How to Add and Edit an Insurance Plan

Quickly add or edit an insurance plan. This function is only available for Insurance Administrators.

Important: It’s likely that all insurances will already be uploaded to the system beforehand. Before adding new insurance, ensure you run a search to see if it is already in the EMR to avoid creating duplicates. If you've mistakenly created a duplicate insurance or have insurances that you'd like to remove from your list, learn how to make them inactive.

Adding an Insurance Plan

  1. Click Add Insurance, located under the Insurance Manager.
  2. Fill out the required information fields: Insurance Name, Phone, Address, City, State, Zip Code, and Country. You can ensure that the payer information is accurate by contacting the insurer.
    1. Therabill Members: As an integrated member, you should include the Payer ID in the Insurance Name field. This will allow you to easily differentiate between insurances with the same name but different payer IDs, allowing you to assign the correct insurance to the patient's case. For more information on the process of insurance mapping, click here.
    2. Insurance Name Field: When filling out the insurance name field, consider entering some additional information that can help identify it as the correct insurance when searching, such as including the PO box of the insurer in the insurance name field. 
    3. Note: Ensure the Type in the Details section is set to the appropriate insurance. A common error is naming the insurance Medicare, but leaving the default insurance type (HMO). This error can end up creating many finalizations with the inappropriate settings. 
  3. You can include payer-specific alerts that will appear on patient appointments (primary payer only) and/or patient charts (primary and secondary payers display). Click here for more information about payer alerts.
  4. Ensure that the proper settings are applied for the insurance.
    1. Apply Therapy Modifiers: This option will automatically apply different therapy modifiers, such as GP, GO, or GN, for all billing codes. This option is checked by default for Medicare insurance types. Some insurers other than Medicare may require these therapy modifiers. For more information, click here
      1. GP: Outpatient physical therapy plan of care
      2. GO: Outpatient occupational therapy plan of care
      3. GN: Outpatient speech-language pathology plan of care
    2. Apply CCI Edits: This option applies Modifier 59 for billing purposes, indicating that you are providing two separate and distinct services during the same treatment period. This option is checked by default for Medicare insurance types. If you have determined that you want to apply CCI Edits to non-Medicare insurance types, it should only be used with government and commercial insurance types (i.e. no workman's compensation, legal/lien, auto liability, etc.).  For more information, click here.
    3. Apply Functional Limitation Reporting: This option will ensure therapists enter required FLR G-codes in the appropriate notes. Important: Medicare no longer requires FLR to be reported. To learn more, review how to remove FLR requirements from Medicare Payers. For more information on FLR for non-Medicare insurance types, click here
    4. Apply Individual CPT Code Billing (Note: Billing integration partners Physicians Resources Limited and Pro PT will not accept this setting): There are some insurances that require each CPT Code to be on its own line regardless of units (this is very rare). Please check with the payer before selecting. 
    5. RevFlow Integrated users should never check this setting. RevFlow automatically enables this formatting for the appropriate payers (BCBS of Massachusetts and Medicaid of Ohio) once charges have reached the billing system.

    6. Apply the 8-Minute Rule: This setting enables 8-Minute Rule calculations for this insurance. If you select this setting, you’ll need to enter the total minutes spent for each CPT code. By default, this setting is always turned on for Medicare insurance types, but can manually be turned on for other insurance types. For more information, click here
    7. Apply the CPT Rule of 8's: This setting enables the Rule of 8's calculations for this insurance on all relevant timed codes that have 15 minutes as the "usual time" in the operational definition of the code. If you select this setting, you’ll need to enter the total minutes spent on each CPT code. By default, this setting can only be applied to non-Medicare insurance types. For more information, click here
    8. Require users to record minutes for CPT codes: This option lets users document the number of minutes spent on each CPT code. This feature is automatically selected when “Apply the 8-Minute Rule (Federal Payers)” is selected but is not required.
    9. Auto-calculate total and direct time minutes: This setting enables the automatic calculation of total direct minutes (i.e., the sum of all minutes spent on direct timed codes) and total treatment minutes (i.e., the sum of all minutes spent on direct timed codes and untimed codes). This is automatically selected when “Apply the 8-Minute Rule (Federal Payers)” is selected but is not required.
    10. Use Complexity-based Codes for Evaluations: This setting will enable the complexity-based evaluation codes to automatically appear in the SOAP note for any date of service 1/1/2017 or after. This setting is automatically checked for all insurance types. For more information on Complexity-based coding, click here
    11. ICD-10 Date Effective: This feature is selected by default for all payers who are not set to “Auto/PIP” or “Other” type and requires that an ICD-10 diagnosis code is added to all patients under this insurance. Payers whose insurance types are set to “Auto/PIP” or “Other” are not required to use ICD-10 and can use ICD-9 codes, therefore this setting box will not be checked automatically. All other insurance types (e.g., HMO, PPO, Medicare, EPO, Medicaid, WCOMP, Tricare, Commercial, Medicare Replacement, POS, GEHA, VA, and employer-based) have the ICD-10 checkbox automatically selected with a 10/1/2015 effective date. For more information, click here.
    12. Require completion of a WebPT Outcomes OMT (Outcome Measurement Tool) Questionnaire for all patients (excludes SLP users): This setting makes the completion of at least one outcome measurement tool (OMT) from the WebPT Outcomes library mandatory for every patient during the following visit types: initial exam, re-exam, progress note, and discharge. Users will not be able to finalize notes for these visits without completing an OMT.
    13. Apply UB-04 Billing: This setting allows Members to use the standard claim form (UB-04) for the facility and ancillary paper billing. This setting is used for Advanced MD, Kareo, and Collaborate MD billing integrations. For more information, click here.
    14. Allow therapist assistants to finalize notes: Check this box to allow assistants to finalize notes for this specific insurance. Remember, the Therapist Assistant Note Finalization clinic setting must be turned on and the assistant must have the Finalize SOAP notes user permission as well, or they will not be able to finalize notes.
    15. Select the Additional Modifiers that will be available for selection on SOAP notes for this payor: Check this box and choose the modifiers you want to use with this insurance from the drop-down. For more information on Additional Modifiers and their setup, click here.
    16. Apply Therapist Assistant Modifiers (CO/CQ): CMS requires modifiers to be applied to services provided by a PTA or COTA for patients with Medicare as the primary or secondary insurance. These modifiers, CQ and CO respectively, should be applied to any service where 10% or more was provided by the assistant. For Medicare-type insurances, this setting is enabled by default and cannot be disabled. For Non-Medicare insurances, check this box to allow the Therapist Assistant Modifiers to be applied to service codes when documenting. Once checked, you must indicate the date the modifiers should start being added. For more information on how to apply these modifiers to services rendered, click here
  5. Click the Add Insurance button.

Editing an Insurance Plan

  1. Click Display Insurance, located under the Insurance Manager.
  2. Search by Insurance Name or Type. You can refine the search by selecting the plan status. Then, click Search.
  3. Click the Edit button for the insurance you are updating. 
  4. Change any information as needed. 
    1. RevFlow Members: As an integrated member, you should never edit the Insurance Name field. If an insurance changes its name, a new insurance profile should be created and new insurance cards should be added for existing patients.
  5. Click the Edit Insurance button to save your updates.