This guide provides step-by-step instructions for properly setting up a Medicare Case and the associated Medicare and Secondary Policies in ChiroHD.
Step 1: Create the Medicare Case
Access the Patient Profile:
Search for the patient using the search box or click their name on the calendar.
Create a New Case:
Click Cases > Create New Case > Medicare.
Important: Only select Medicare as the case type if the patient has U.S. government-issued Medicare.
If the patient has a Medicare replacement plan, use Insurance as the case type instead.(Optional) Update the Case Name if desired.
Select Bill Normally.
Click Save Changes.
Set this Medicare case as the patient's Default Case if appropriate.
Step 2: Enter Diagnosis Codes (DX Codes)
Open the Medicare Case.
Navigate to Treatment DX.
Add DX Codes:
Search for the diagnosis name or ICD-10 code.
The system will default the start date to today’s date — adjust if needed.
Tip:
Setting the start date on the first DX code will apply the same start date to all additional DX codes entered.
Step 3: Add the Primary Medicare Policy
Go to Insurance > SL Coverage.
Click Add New Insurance SL Coverage.
Complete the Coverage Information:
Third Party Payer: Select Medicare from the list.
Priority: Select Primary.
Coverage Dates: Enter the start and end dates for the patient's Medicare coverage.
Member ID: Enter the Medicare ID number from the patient's card.
Group Identifier: This will be hardcoded as NONE (required for Medicare claims).
(Optional) Plan Identifier / Prior Auth Number: Enter if applicable.
(Optional) Notes: Add any relevant notes.
Billing Details:
Enter Co-Pay Amount and Max Visits if needed.
Setting a Max Visits limit triggers a notification when the limit is reached, but it only appears on the SOAP note screen. (Consider also setting up an alert for the front desk.)
Box 14 & 15 Setup (Important for Medicare):
Click Show Nonstandard Fields to open box 14 and 15.
Box 14 (Onset of Current Symptoms):
Enter the onset date and set qualifier to 431.
Box 15 (Initial Treatment Date):
Enter the first visit date and set qualifier to 454.
Referring Provider:
If your Medicare payer requires a referring provider, select it from the dropdown.
Save the Primary Coverage.
Step 4: (Optional) Add a Secondary Policy
If the patient also has a secondary policy (common for Medicare patients):
Click Add New Insurance Coverage again.
Select the Secondary Insurance (e.g., Aetna).
Set Priority: Select Secondary.
Enter Member ID and Group Identifier from the secondary insurance card.
Fill in the same Box 14 and 15 setup as the primary policy.
Save the Secondary Coverage.
Step 5: Set Default Services (Optional)
Go to Default Services and select the services that should automatically populate for this case.
Example: Medicare Adjustment.
Click Save Changes.
Step 6: Final Settings
Settings Tab:
You can rename the case if desired (e.g., “Medicare 2024”).
Keep Billing Type set to Bill Normally.
Do not change the Case Type — it must remain as Medicare.
Save Final Settings.
Important Notes
Never use the Medicare case type unless it is true U.S. government-issued Medicare.
The system automatically enforces special Medicare rules such as:
Hardcoding Group Identifier to “NONE”.
Requiring proper completion of Box 14 and Box 15.
Medicare claims missing these fields are likely to be rejected, resulting in billing delays.
Adding a secondary policy allows for automatic payment posting once Medicare forwards the claim to the secondary insurer.
By following this setup, you will ensure that Medicare patients are billed correctly and reduce the risk of claim denials.