Function

Global

Description

Carriers

Y

Maintain insurance carriers

Carrier Types

Y

Maintain carrier types (Medicare, etc.) for reporting purposes

Plans

Maintain insurance plans

Plan Types

Y

Maintain plan types (Medicare, etc.) for reporting purposes

Fee Schedules

Maintain Fee Schedules which are tied to plans

Rate Structures

Maintain Rate Structures which are tied to plans

Networks

Maintain Pricing (HMO, PPO, etc) Networks which are tied to plans and used for reporting purposes

Network Types

Y

Maintain Network Types (HMO, PPO, etc) which is used for reporting purposes

Contacts

Maintain Contacts (people) for plans, employers, etc.

Contact Types

Y

Maintain Contact Types (Eligibility, HR, etc) for contacts which is used for reporting purposes

Contract Types

Y

Maintain Contract Types (Managed Care, etc.) which is used for reporting purposes

Claim Editing Indicator

Y

HCFA (CMS) Claim Edit Indicator for electronic claims

Claim Payment Source

Y

HCFA (CMS) Claim Payment Source for electronic claims

Payer Type

Y

Payer Type (Medicare, Medicaid, etc.) for claim control

Claim Formats

Paper Claim Formats

EMC Claim Formats

Electronic claim format and control information for the practice

EMC Claim Formats - Plan

Electronic claim format and control information for specific plans