Setting the default claim settings can only be done by the organization and the administrators with Manage settings permission in the Claims section of the Permissions module. To set the default claim settings, click on the Claims module icon at the top of the page and, when the drop-down appears, click on Settings.

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It will populate the Claim Settings page onto the screen. Click on Default Settings  to access the set up page.

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In the Default Settings page, there will be 4 fields that can be set up for a specific employee contact. Each field relates to certain information that will be filled in automatically when the claim is generated and will populate to their designated boxes when the claim is exported to HCFA 1500 forms/EDI files. As such, it is advised that each of the fields are set up with the correct employee contact, so that each of the fields carry the correct information and the claim can be sent to the gateway without any issues.

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  • Billing: Box 33 of HCFA 1500. This information derives from the selected employee’s Claims Settings area in the contact. Gives the billing provider’s name, address, NPI, EIN, and the phone number.
  • Referring: Box 17 of HCFA 1500. This information derives from the selected employee’s Claims Settings area in the contact. Gives the referring provider’s name and the NPI number.
  • Provider/Supplier: Box 31 of HCFA 1500. This information derives from the selected employee’s Claims Settings area in the contact. Provides the name of the physician or supplier and NPI.
  • Facility: Box 32 of HCFA 1500. This information derives from the selected employee’s Claims Settings area in the contact. Gives the name, address, NPI, and the phone number of the facility/location in which the service was provided.