Electronic Benefit Verification: Insurance Mapping
Electronic Benefit Verification allows you to easily verify your patient insurance benefits directly from the EMR. Once enabled you will need to map your EMR Insurances to an Electronic Verified Payer. Click here for the full Electronic Benefit Verification overview.
IN THIS ARTICLE
Insurance payers need to be mapped to an Electronic Verified Payer to allow for benefit verification. Only users with Insurance Admin permissions are allowed to add/edit insurance and map insurance payers. For information regarding changes to User Permissions, click here.
- If the insurance payer is not already in use in WebPT EMR, click Add Insurance from the Insurance Manager. Learn more about adding insurance here.
Map the insurance using the Electronic Verified Payer drop-down to search for and select the correct electronic verified payer match.
- Complete all required and any additional insurance details, then click Add Insurance to save the insurance.
- For existing Insurances, click Display Insurance to search for and edit the insurance then follow steps 1-3 above to map the Electronic Verified Payer.
Insurance Mapping Tips
Some payers prefer for their insurance plans to be mapped to verified payers in a particular way. Additionally, not all payers participate in the electronic benefit verification process. When mapping insurances, keep these tips in mind:
A) Use the Export Electronic Payer List to determine the mapping source instead of depending on the payer drop-down to match the Electronic Verified Payer within the insurance payer settings. You can find the Export Electronic Payer List link by clicking on Display Insurance from the Insurance Manager menu.
- There may be payers who are not on the list as not all payers are currently offering electronic verification of benefits.
- HMAA - Hawaii Medical Assurance Association is not supporting benefit transactions at this time
- Tricare East does not currently provide electronic benefits for Professional Services/Physical Therapy
- Larger insurance companies often identify their subsidiary insurance companies regionally or by state. These insurance companies may require you to choose the top payer in the hierarchy to obtain benefits. In the following examples, you would choose the bolded insurance payer:
- AARP Medicare Advantage > United Healthcare
- Humana Gold Plus > Humana
- Medicare Plus Blue PPO> BCBS of Michigan
- If you are used to finding specific payer IDs when submitting claims, for this transaction type, we recommend locating the top payer or main payer name.
B) For all Medicare type insurances, select Medicare Part A and B from the Electronic Verified Payer drop-down.
C) For Medicare Replacement type insurances (Medicare Advantage plans), map the insurance to the electronic verified payer of the company providing the plan. (For example, a Medicare Advantage plan provided by Aetna should be mapped to Aetna’s verified payer, not Medicare Part A and B.)
D) Mapping Blue Cross Blue Shield (BCBS) out-of-state plans to your local or regional brand may result in rejected benefits.
- Use Blue Exchange for out-of-state Blue-type home plans, to help avoid benefit rejections.
For any in-state BCBS plans, or BCBS owned plans (such as Highmark), we recommend mapping to the Blue Cross Blue Shield verified payer for your state.
You can potentially avoid these rejections, by adding an additional Insurance Payer profile and mapping it to Blue Exchange.