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 bar.
OR click on their name on the calendar.
Click on the Cases tab, and click Create New Case.
Choose from the dropdown menu, Medicare Case Type.
Select Bill Normally.
Click Save Changes.
Important NOTE: Only select Medicare as the case type if the patient has U.S. government-issued Medicare. If the patient has a Medicare replacement or Advantage plan, use Insurance Case Type instead.
Optional Default Case:
Set the newly created Medicare Case as the patient's default case by clicking the push pin icon.
Step 2: Enter Diagnosis Codes (DX Codes)
Open the Medicare Case < Treatment / DX Tab.
Add Diagnosis Codes by clicking in the Add code to case.
Choose the Start Date (It will default to today’s date).
Save Changes.
Tip: If you backdate the first DX code, subsequent codes will use the same start date automatically.
Step 3: Add the Primary Medicare Policy
Go to Insurance /Coverage Tab, click Add New Insurance.
Complete the Coverage Information:
Third Party Payer: Select Medicare from the list.
Priority: Select Primary or Secondary.
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):
NOTE: Box 14 and 15 will always show on a Medicare case without having to click Show Nonstandard Fields.
Box 14 (Onset of Current Symptoms):
Enter the onset date and set qualifier to 431.
Box 15:
Enter the first visit date and choose the appropriate qualifier for the case (454 for Initial Treatment Date).
Referring Provider:
If your Medicare payer requires a referring provider, select it from the dropdown.
NOTE: If the field has a blue line on the side of it, this field is required.
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”. See information on this below.
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.
Troubleshooting Tips with Medicare Cases
NONE in Group Identifier (box 11)
If there is a Secondary Insurance on a Medicare case, Box 11 will be hardcoded with the Group Identifier to “NONE”. This is a safe guard against claim rejection. Putting NONE in box 11 states that there is no primary insurance except Medicare.
By following this setup, you will ensure that Medicare patients are billed correctly and reduce the risk of claim denials.