Insurance: Insurance Settings

Use the Insurance Settings page to configure the default information that appears on all electronic claims. These settings apply practice wide unless you create specific payer customizations.

In this article:

• Enabling Insurance Features
• Understanding Insurance Settings
• Adding Payer Customizations
• Frequently Asked Questions
• Related Resources

Enabling Insurance Features

Go to Billing Settings > Insurance and check Insurance features enabled. This unlocks insurance billing tools, including payer setup, enrollments, and claim submission.

Understanding Insurance Settings

You can find these settings under Billing Settings > Insurance > Settings. These fields populate the key boxes on the CMS-1500 claim form. Confirm each item before submitting your first claim.

EIN or SSN

Enter the tax ID used when contracting with your insurance payers. This may be your business EIN or your personal SSN.

Who will be the Billing Provider in Box 33?

Choose whether claims should list an Individual or Organization as the billing provider.

• Individual is common for solo practitioners.
• Organization is common for group practices or anyone billing under a business entity with an EIN.

Billing Provider Name

Defaults to your account name. You can override this if your legal billing name differs.

NPI

Enter the NPI used for insurance billing. This may be a Type 1 for individuals or a Type 2 for organizations. If you are unsure which one your payers expect, check your contract or contact the payer.

Taxonomy Code

Use the taxonomy code associated with the NPI you entered.

Which address will be used for the Billing Provider in Box 33?

Choose whether to use your primary account address or enter a custom billing address.

Phone Number

Use your primary account phone number or enter a custom number for claims.

Show Service Facility Location in Box 32?

Turn this on if a payer requires the service facility address on claims. This is typically used when the place where services occur is different from your billing address, such as a satellite office or secondary location.

Include Pay-to Address in Claims?

Turn this on only if payments should be mailed to a location other than the Billing Provider address. Most practices leave this off unless a payer specifically requires a separate pay‑to address.

Include Multiple Diagnoses in Claims?

Enable this if you want claims to include multiple diagnosis codes when applicable.

Adding Payer Customizations

If you need different claim settings for a specific payer or practitioner, scroll to the bottom of the page and select Add Customization. Customizations override the default Insurance Settings for the selected payer or provider.

Common uses include:

• Billing one payer under a different NPI
• Using a different billing provider name for a specific practitioner
• Routing claims through a supervisor as the rendering provider

Frequently Asked Questions

Why is the Billing Provider set to Individual or Organization?

This determines what appears in Box 33 on the CMS-1500 form and should match how you contracted with the payer.

Which NPI should I use here?

Use the NPI payers expect for your claims, which may be a Type 1 for individuals or a Type 2 for organizations.

When should I turn on the Service Facility Location field?

Turn it on only if a payer requires Box 32 on electronic claims.

What does the Pay-to Address option do?

It adds a pay-to address to claims for payers that require it.

Should I include multiple diagnoses on claims?

Enable this if you routinely bill more than one diagnosis and your payers accept multiple codes.

Can I override these settings for one payer or one practitioner?

Yes, use Add Customization to create payer-specific or provider-specific claim rules.

Related Resources

For more help with insurance billing setup, explore these related resources.

• Guide to Getting Started with Insurance
• Insurance: Account Set Up
• Insurance: Insurance Customizations