Insurance Naming Convention Requirements for Sammy
In SammyEHR with the release of version 5.06.0339 of Libraries Insurance, Dr and Facility Update (ilib.exe) when entering insurance companies an alert is now displayed to the user if the proper naming conventions are not used.
Many of the programs in Sammy such as Billing, Medicare Universal and Autopost have specific coding guidelines vased on the name of the insurance entry. These guidelines dictate how claims are processed, claim file creation and Autopost processes claims.
- Medicare (red, white and blue insurance card) must be the first 8 characters in the insurance library entry.
- Medicaid (State Government) must be the first 8 characters in the insurance library entry.
- When it is a Medicare HMO’s (Advantage Plans Part C) use MCR HMO example: Aetna MCR HMO
- When it is a Medicaid HMO’s use MCD HMO for example: Aetna MCD HMO
- For reporting, we would like all Blue Cross Blue Shield Companies to have BCBS in the name.
- For DME, (red, white and blue Medicare card) MEDICARE must be the first 8 characters followed by DMERC.
- For other DME carriers, they cannot use MEDICARE or MEDICAID in the first 8 characters of the insurance entry name. For example Aetna MCR DME HMO, or Aetna MCD DME HMO.
- Medicare carrier must have begin Medicare
- Medicare HMO's must contain MCR HMO
- Medicaid HMO's must contain MCD HMO
- Medicare DME Carrier's must be named Medicare DMERC