Overview
Insurance overrides in ChiroHD allow you to customize the information displayed on claim forms to meet specific payer requirements. Whether you need to adjust details like Box 32 and Box 33 information or handle unique provider credentialing scenarios, overrides provide a flexible solution. This guide outlines the steps to set up and manage insurance overrides effectively.
When billing insurance, you might need different information displayed on a claim form than what is typically defaulted in ChiroHD. For example:
A specific payer might require different information in Box 32 and Box 33.
A provider may be credentialed only with a Type 2 NPI for certain payers (e.g., Blue Cross Blue Shield).
In such cases, you can set up insurance overrides to customize the claim form details as needed.
Accessing Insurance Overrides
To access and set up insurance overrides:
Navigate to your Live Location > Insurance tab > Settings > Overrides.
Click Add Override to create a new override.
Note: You must have insurance permissions assigned to your user profile to access the Insurance tab.
Overrides are tied to a third-party payer and a rendering provider, functioning like an "if-then" statement:
If a specific provider is rendering for a specific payer,
Then apply customized information to the claim form.
Creating an Insurance Override
1. Name the Override
Give the override a clear, descriptive name (e.g., “Blue Cross Blue Shield Override”).
2. Set Start and End Dates (Optional)
Specify a date range if the override should only apply to services rendered during a particular period. If left blank, the override applies indefinitely.
3. Fill Out Override Fields
Third-Party Payer:
Select the payer.
Configure payer-specific options, such as:
Paper billed
Uses referring provider
Uses provider taxonomy code
Uses NPI Type 2 taxonomy code
Rendering Provider:
Enter provider-specific details:
Provider’s name
Individual NPI
Tax ID (EIN or Social Security)
Provider signature and suffix
Example: If a provider is credentialed only with a Type 2 NPI for Blue Cross Blue Shield, enter the Type 2 NPI in the relevant field.
Box 32 and Box 33 Information:
Customize Box 32 (Service Facility Location) and Box 33 (Billing Provider Info) details for the payer.
Example: A provider’s Box 32/33 information may differ for Blue Cross Blue Shield compared to other payers.
Setting Up an All-Payer Override
If the override should apply across all payers:
Name the override.
Set the start and end dates if needed.
Select the rendering provider.
Leave the third-party payer field blank.
Fill out any details that should be overridden for all payers.
When Overrides Are Applied
Overrides are applied during the billing process as follows:
Claims are added to the Create Claim Queue, where standard/default billing settings are initially applied.
When you click Create Claim, the system:
Validates the claims.
Applies any applicable overrides based on the rendering provider and payer.
Overrides are applied to both electronic and paper claims. You can preview claims and verify override settings by viewing them on the HCFA form.
Handling Rejections and Retroactive Overrides
If claims are rejected and require an override:
Set up the override in Insurance > Settings > Overrides.
Important: Overrides cannot retroactively update claims. To apply the new override:
Set the affected services to "rebill."
Process the claims again through the Create Claim Queue. The override will be applied during this process.
By using insurance overrides in ChiroHD, you can ensure claims comply with payer-specific requirements and streamline your billing workflow.