OfficeMate Home Office User's Guide - OfficeMate Software Solutions

Setting Up Insurance Plans
Chapter 2 Setting Up Insurance Carriers & Plans
Select Yes from the Prevent Discount on Fee Slip radio buttons to prevent
discounts over and above any discounting that is part of this insurance plan that
could cut into your margin. Select No to allow additional discounts.
Select Yes from the Eligibility Required radio buttons if an eligibility
number is required for this plan. Select No if eligibility is not required.
Select Yes from the Authorization Required radio buttons to require patients’
authorization ID on the Eligibility window. After you set up this preference, you
must ensure that patients using this insurance plan have their authorization ID
recorded on the Carrier window. Select No if authorization is not required.
For each of the pairs of radio buttons in the Combining Attributes group, select
Yes or No.
Notes
Select Yes from the Split Frame radio buttons to split the frame cost to two
lines on the CMS 1500. Select No to list frames as a single line item on the CMS
1500 and go to step 10.
Note
• Selecting the Yes radio button combines two or more items with
the same CPT code onto one line on the insurance claim. The
quantity on the claim reflects the number of items, and the
charges on the claim reflects the sum of the charges for the
individual items.
• Selecting the No radio button lists each item as a separated line
item on the insurance claim.
When the frame cost is split, the first line is entered on the CMS
1500 with a V2020 code. Any amount above the price point you
select in step 9 is split onto the second line with another code,
usually V2025.
If you selected to split the frame cost in step 8, type the price point at which the
frame is split in the Split @ field and select a billing code from the
CPT/HCPCS drop-down menu.
Select the frame and contact pricing range that appears on the CMS 1500 from
the Pricing Range radio buttons.
In the Exam Elig. Period spin box, type the number of months in which the
plan states the patient may return.
From the Recall Type drop-down menu, select the recall type for the plan.
Select Yes from the Transfer Co-Pay to Secondary Insurance radio
buttons if the plan allows a secondary insurance to pay the copay. Select No if
the copay cannot be transferred to a secondary insurance.
124 OfficeMate Home Office User’s Guide