Automated Eligibility Verification – The Most Efficient Way to Perform the Most Critical Step in Medical Billing

If you’re not checking eligibility, you risk not getting paid.

If you’re manually checking eligibility, you’re wasting time on something that can be automated.

Nobody wants to work for free! But that is exactly what happens when a patient is seen, and the claim for services rendered is uncollectible because the patient didn’t have coverage.

The cost of that service extends beyond just the providers’ time. There is also cost associated with the staff that scheduled the appointment and checked the patient in and out. There is also cost associated with the nurses, medical assistants, and billers that took the time to send out the claim. The most critical step in medical billing is verifying patient eligibility before the patient is seen. There is a good, better, and best way to check patient eligibility!

When to check eligibility:

New Patients

When a new patient calls to schedule an appointment, an office should first ask for insurance information and run an eligibility check to verify coverage. It’s not just good for the practice; it’s a matter of good customer service. 

No patient wants to find out after their service that the practice doesn’t take their insurance or that they are out of network. Having information regarding coverage and the deductible allows practices to have up-front conversations with new patients to make informed decisions.

Scheduled Appointments

There are so many factors that can impact changes in healthcare coverage. Lost jobs, employers changing insurance companies, employees selecting a different option offered by their employer, deciding to switch coverage to a spouse’s plan, and on and on.

These changes can come at any time. Because appointments can be scheduled months in advance, verifying eligibility for every appointment a few days prior is best practice. This allows the practice time to address eligibility changes with a patient before seeing them.

And just as a tip- if the appointment falls on the first day of the month, it’s always a good idea to recheck it that day because most plans term on the last day of the month.

The “good/better/best” for verifying eligibility:

Good: Call the insurance company to verify.

The downside of this method is that it can take a lot of staff time. Even if you have a dedicated staff member to make calls for all scheduled appointments, they can’t always get it done. It is common for staff to get interrupted with other duties or get stuck waiting on hold for extended periods. And because of how much time it can take, there is an increased risk that it won’t ever get done.

Better: Verify eligibility online.

Many insurance companies allow you to verify insurance through their website or the clearinghouse. While this is more efficient than calling the insurance and getting stuck on hold, it is still a manual process to go to the site or clearinghouse and key in the information. The impact of this method is the drain on staff time and a high risk that it won’t be completed 100% of the time.

Best: Real-time and Scheduled Eligibility checking directly from Medisoft. 

When you use Medisoft EDI, you unlock the real power of automation because everything is tightly integrated directly into Medisoft.

For example, when registering a new patient, you can enter the insurance information and do a real-time eligibility check with the click of a button. No leaving the window, no making phone calls, and no re-entering the same patient demographic and insurance information over and over! Eligibility information is pulled right back into Medisoft in the patients’ case and in Office Hours.

What about all those scheduled appointments? Medisoft can automatically run eligibility for an entire day of appointments all at once a few days in advance. This way, you know which patients still have coverage and which ones to reach out to before they come. Real-time checks can also be done when scheduling existing patients to verify the insurance on file is up to date.

Are you ready to automate eligibility checks?

Learn how to automate eligibility in Medisoft with this video.

Automating eligibility is so easy, and is super helpful to your practice!

  • Save time by not being on the phone for hours
  • Save the hassle of rescheduling and canceling appointments
  • Maximize profits by avoiding seeing patients for free!

On top of this, check out the 6 Ways the Medisoft Clearinghouse will legitimately save you boatloads of time and money in Medisoft

Read the post here: 6 Ways Medisoft EDI saves you money

Give us a call today!

We know firsthand how scary it can be to switch to a new clearinghouse. Rest assured, we’ve helped hundreds of practices make the switch, and we’ll make it a quick and painless process for you.

Call us today to ask your questions, to get the details, and to discuss the process for moving from your current clearinghouse to the Medisoft Clearinghouse.

Let us help you get to a place where you can enjoy extra time, a streamlined and straightforward electronic claims process, and maximized revenue.

AZCOMP Technologies – the #1 eMDs reseller for Medisoft since 2005.

We are the ultimate source for all things Medisoft. Whatever your question, problem, or need with Medisoft, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as the Medisoft preferred clearinghouse, patient statements, patient payments, appointment reminders, and more.

For more information, visit our website here:

Be sure to call us at (480) 730-3055 for all your Medisoft and healthcare technology needs.

How to Add Modifiers in Medisoft in Two Simple Ways

Did you know Medisoft has the ability to add additional modifiers, allowing you to use more than one?

This quick video (2 mins) will show you how to add and/or default modifiers in your claims. This will also show you how to move your column next to procedure codes in Medisoft, to make it more convenient for you to access.

How does this relate to Telehealth?

(The following information was updated on April 6, 2020 after a correction by CMS was published on April 3, 2020)

The following is a list of Telehealth related Modifiers that may be applied to a claim:

  • 95 Modifier – Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified healthcare professional and a patient who is located at a distant site from the physician or other qualified healthcare professional.
    (When billing professional claims to Medicare for all telehealth services with dates of services on or after March 6, 2020, and for the duration of the Public Health Emergency (PHE), bill with Place of Service (POS) equal to what it would have been had the service been furnished in-person with modifier 95, indicating that the service rendered was actually performed via telehealth)
  • GT Modifier – The GT modifier is used to indicate a service was rendered via synchronous telecommunication. Distant site services billed under CAH method II on institutional claims still require modifier GT.
  • GQ Modifier – For Alaska or Hawaii only. Services delivered via asynchronous telecommunications system. This modifier may be submitted with telehealth services. Generally, interactive audio and video communications must be used to permit real-time communication between the distant site physician/practitioner and the Medicare beneficiary

COVID-19 Specific Modifier to Indicate the Waiver of Deductibles, Co-payments and Co-insurance for Medicare Patients

(The following information was added on April 9, 2020 to include information provided by CMS in a Special Edition Newsletter from the Medicare Learning Network dated April 7, 2020)

Providers are to apply modifier CS on applicable claim lines to identify COVID-19 testing-related services that are not subject to cost sharing under the Families First Coronavirus Response Act. Covered services include medical visits that that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test. The effective date for modifier CS is for services performed between March 18, 2020 through the end of the Public Health Emergency.

For professional claims, physicians and practitioners who did not initially submit claims with the CS modifier must notify their Medicare Administrative Contractor (MAC) and request to resubmit applicable claims with dates of service on or after 3/18/2020 with the CS modifier to get 100% payment. 

For institutional claims, providers, including hospitals, CAHs, RHCs, and FQHCs, who did not initially submit claims with the CS modifier must resubmit applicable claims submitted on or after 3/18/2020, with the CS modifier to visit lines to get 100% payment.

You can find out more information regarding telehealth on this recent blog post.

Check out the video here!

AZCOMP Technologies – the Number 1 eMDs reseller for Medisoft since 2005.

We are the ultimate source for all things Medisoft. Whatever your question or problem or need with Medisoft, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as the Medisoft preferred clearinghouse, or patient statements, patient payments, appointment reminders and more.

For more information, visit our website here:


Get AZCOMP’s Help

If you are having any problem with Medisoft whatsoever, we can solve it for you. Also, if you’d like to get more out of Medisoft…meaning, if you’d like to take Medisoft to the next level and have it become a powerful tool for your practice, we can help you get there!

We can help with speeding up your electronic claims process and help you save time. We can help you streamline your patient statements process, and make it so your patients can pay you online while you sleep. We can set Medisoft up for you to automatically remind your patients of their appointments and confirm their attendance. We can help with more as well.

Please give us a call at (877) 671-7501 to talk to a Medisoft specialist and we’ll help you get the most out of Medisoft!

How To Requeue A Remit For Your Revenue Management Reports

How To Re-Queue A Remit For Your Revenue Management Reports

Do you ever get an ERA that doesn’t show up in your reports?

Sometimes when you submit claims the remit doesn’t come into your reports, so you need to requeue this. The remit may not come through for a few different reasons. In this video, we will show you how to requeue the remit.

This video is specific to the Relay Health Clearinghouse using Revenue Management in either Medisoft or Lytec.

If you’re having any other troubles that you need help with, be sure to leave us a comment in the comment section of the video. If you like the video then let us know by giving us a “thumbs up”!

Watch the video now…

Need More Video Help?

Be sure to check out all our other ICD-10 and Medisoft training or support videos and subscribe to our channel!

How to Fix Claim Rejections Because of No Procedure Code Description

How to Fix Claim Rejections Because of No Procedure Code Description

If you get rejected claims for not having a procedure code description, sometimes the claim might come back as being rejected for Loop 2400 SV101-7. This video will show you how to handle this, or how to fix this so that you can resubmit the claim along with the procedure code description.

Check out the video here:

Did this video answer your question? Hopefully it did! If not, we have 100’s of more DIY support videos on our YouTube channel and right here on our blog. Just search for what you are looking for and watch as many videos as you have the time for.

Need professional help? Running short on time? Can’t quite get Medisoft to work the way you want it to? AZCOMP provides the most phenomenal support experience in the entire country and you can get them to help you an UNLIMITED amount by becoming a Platinum Member. Plans start as low as $99 per month.


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Medisoft ICD-10 Frequently Asked Questions

Medisoft ICD-10 FAQ

October 1, 2015 has come and is now gone and the AZCOMP support department has been busy to say the least. The phone is ringing almost non-stop and we’re getting the same questions over and over. So we’ve put together this list of Frequently Asked Questions.

We’ve compiled this same list on our ICD-10 resource page, so be sure to check there for future updates. If there are more FAQ’s to add, we’ll add them on that page.

Here is a list of the current top 5 most frequently asked questions about ICD-10 and Medisoft.

#1: Why are my codes showing in red in Medisoft transaction entry?

This first video answers a question about why the old ICD-9 codes are showing in red when you try to enter new charges in the Transaction Entry screen as well as give some insight as to why ICD-9 codes still show. This video will also show you how to change the default diagnosis in the patient’s case from ICD-9 to ICD-10. Watch the video above to get help with this.

#2: Why are my old ICD-9 codes showing in transaction entry?

This video builds on the first video. A lot of people have been wondering why the Transaction Entry screen in Medisoft is still showing the old ICD-9 codes instead of the expected ICD-10 codes. This is a very common point of confusion that is addressed in this video. Watch the video above to get the confusion cleared up hopefully.

#3: Why are there no codes to map when I go into the code mapping tool?

This third video covers a question about the ICD-10 mapping utility in Medisoft. Many people have had questions about how it works and why there are no codes displayed or available to map when they go into the tool. Be sure to watch this video if you are having those problems.

#4: Why are my electronic claims getting rejected, and what is an ICD-10 qualifier?

This video is regarding electronic claims rejections. We’ve had many instances of electronic claims being rejected because the ICD-10 qualifier is sending a “BK” or “BF” rather than the needed ICD-10 qualifier of “ABK” or “ABF”. This video will show you how to resolved this common problem. Watch this video to learn how to solve these problems if you are experiencing claims being rejected.

#5: I still can’t send claims. Why can’t I submit my claims?

Video 5 explains why electronic claims are being rejected for users who send claims in “text file” or “print image” format using the CMS11 program. This will be a 2-part answer.

First, watch this short one-minute video to determine if you are sending claims in the old format:

If it is determined that you are sending claims in “print image” using the CMS11 or CMSFILE, watch this other video (which is the same as the video above at the beginning of this answer) on what this means to you:

We recommend you call your AZCOMP account representative at (888) 799-4777 to proceed forward with the implementation of Revenue Management. If you are currently using Revenue Management to send claims electronically this video will not apply to you and there may be other issues our support department will need to look at for you.

Need More Help?

If these videos don’t answer your questions, call AZCOMP for technical support and training!

We can help you with Medisoft and ICD-10 challenges with a support agreement starting for as little as $99 per month! We have support plans to fit all different sizes of practices as well, so give us a call to get started on your Platinum Support Membership.

Visit our ICD-10 Resource Page

Be sure to check out our ICD-10 Resource Page for more updates, more videos, more training and more information.

New Place of Services Code Created by CMS

New Place of Service Code

Ask the Coder

By Lisa A Schroeder, CHC, CPC, CCS-P, Compliance – Academic, Office-based and Multi-specialty Physicians, McKesson Business Performance Services | August 31, 2015

Place of Service Update

The plan to update Place of Service (POS) codes for outpatient hospital services was announced in the CY 2015 Physician Fee Schedule (PFS) Final Rule. In that Final Rule, the Centers for Medicare and Medicaid Services (CMS) noted that with the proliferation of physician practices becoming hospital based, CMS lacked a means to adequately determine the expense incurred by a practice versus the expense incurred by a hospital outpatient department. The Practice Expense (PE) is one of the components of the Relative Value Unit (RVU) and is used to determine the fee schedule amount1. In the CY 2015 PFS Final Rule, CMS was also looking for ways to more accurately value visits within the postoperative period.2 Though the Final Rule decided on new POS codes under Part B to help with the assessments, it did not recommend the new code at the time of publication.

On Aug. 6, 2015, CMS issued details regarding the new and revised POS codes under Part B in MLN Matters MM9231 (PDF, 69 KB). These changes will become effective Jan. 1, 2016. To differentiate between on-campus and off-campus provider-based hospital departments, CMS is creating a new POS code – POS 19 and revising the current POS 22 code description for outpatient hospital. These changes will affect physicians, other providers, and suppliers submitting claims to Medicare Administrative Contractors (MAC), including Durable Medical Equipment Medicare Administrative Contractors (DME MAC) for services provided to Medicare beneficiaries under Part B3.

POS Code Set – Outpatient changes4


What does this mean to physicians and practitioners?

  • To file a claim, the outpatient POS must be correctly identified. Either the hospital outpatient location is on campus, (POS 22) or it is off campus (POS 19).
  • Payments for services provided to outpatients who are later admitted as inpatients within three- days (or, in the case of non-IPPS hospitals, one-day) are bundled when the patient is seen in a wholly owned or wholly operated physician practice. For those services that have a technical component (TC) and a professional component (PC) split in the PFS, Medicare will continue to pay the facility rate for the PC when provided within the three-day, (or one-day), window.
  • Claims for covered services rendered in an Off Campus-Outpatient Hospital setting (or in an On Campus-Outpatient Hospital setting, if payable by Medicare) will be paid at the facility rate. This also applies to those services with a professional fee only, that is no PC/TC split.
  • Reporting outpatient hospital POS code 19 or 22 is a minimum requirement to trigger the facility payment amount under the PFS when services are provided to a registered outpatient. Therefore, you should use POS code 19 or POS code 22 when you furnish services to a hospital outpatient regardless of where the face-to-face encounter occurs.

MM9231 also mentions minor corrections to POS codes 17 – Walk-in Retail Health Clinic and 26 – Military Treatment Facility. These two codes have been added back to the POS list in the “Medicare Claims Processing Manual”.

To view the related Change Request (CR) 9231 (Transmittal 3315) which includes the update to CMS Manual System Publication 100-04 Medicare Claims Processing Manual, click here (PDF, 225 KB).

1 Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to
Identifiable Data for the Center for Medicare and Medicaid Innovation Models & other Revisions to Part B for CY 2015, 79 Fed.
Reg. 67547, 67569 (November 13, 2014) (to be codified at 42 CFR 403, 405, 410, et al.).
2 Ibid.
MLN Matters® Number: MM9231 Related Change Request (CR) #: CR 9231 Related CR Release Date: August 6, 2015 Page 1
Ibid at Page 2.

Notice Regarding Print-Image Files and ICD-10

Are you still submitting claims to your clearinghouse using “Print-Image” files?

If you are still using the print image method for submitting claims, you need to start submitting using the new CMS 1500 02/12 claim form or your cash flow will be negatively impacted.

As October 1, 2015 approaches, the primary concern for all providers is whether or not they will continue to receive revenue as the entire industry makes the biggest transition in healthcare in 35 years! While many practices are finishing off the tail end of their ICD-10 Action Plans, and are well on their way to a smooth transition, we have recently seen a surge in calls from practices that have not yet completed ICD-10 testing with their clearinghouse and payers.

As we are assisting practices with their testing, we are finding a higher than expected number of practices that are sending print image files to their clearinghouses. Most clearinghouses cut off the use of print image files when the industry shifted to the new CMS 1500 02/12 form back on April 1, 2014. However, there are still a few outliers that continued to allow users to submit print image files.

Keep in mind that HIPAA required all electronic transactions to be submitted in the ANSI 5010 format as of January 1, 2012.

In order to comply with this new standard, Medisoft built the capability to submit claims in the 5010 format directly from the program through the Revenue Management module. If you are not using Revenue Management then you are submitting claims in a print image format to your clearinghouse. Then the clearinghouse is converting the print image file for you to the ANSI 5010 format and forwarding it on to the payers.

How You Can Find Out If You Are Sending “Print Image” Text Files

Typically the print image format comes from a file that is formatted based on the HCFA claim form fields. In Medisoft and Lytec the most common method of producing the print image file was by setting up an EDI receiver to launch an executable file called CMS11.exe. Here is a sample of what you may see when you are sending claims that notifies you that you are sending a “print image” text file.

medisoft cms11 text file print image

Or you can watch this short video where we show you in Medisoft how you can find out if you are sending “print image” files.

Don’t Let Your Claims Get DENIED

As of Medisoft v19 and Lytec 2014, Medisoft and Lytec discontinued support of the cms11.exe file. It was never updated to match the new claim form or to handle ICD-10 codes. Therefore, if you are still relying on this method to submit claims there is a very high likelihood that your ICD-10 claims will be DENIED starting October 1, 2015.

While some clearinghouses may continue to support print image file submissions, our understanding is that they will require you to use a print image file that produces a print image of the CMS 1500 02/12 claim form. Please take note that the CMS11.exe file produces the old 08/05 claim format and that print image submission is not supported in Medisoft or Lytec.

Get On Board With Revenue Management

The good news is Medisoft v19 (and Medisoft v20) and Lytec 2014 (and Lytec 2015) are both equipped with not only the new 02/12 claim forms, but also with Revenue Management. The Revenue Management module in Medisoft and Lytec can be configured to send claims to any clearinghouse or even directly to the payers in the 5010 format.

In addition, Revenue Management has features such as claim scrubbing and ERA posting that your practice can take advantage of to streamline billing processes.

revenue management claim check screen shot

While the Revenue Management application is included with the ICD-10 compatible versions of Medisoft and Lytec, it does require setup and configuration to successfully utilize it. If you need to get setup on Revenue Management please call us at (888) 799-4777 to schedule the configuration with an EDI Professional!

If You Need Revenue Management Configured, Don’t Wait!

Please do not wait to contact us as the backlog of practices that need configuration and training is growing and our availability is based on first come first serve.

We also highly recommend contacting your clearinghouse as soon as possible to discuss this change, and to coordinate the switch from the print image file to the ANSI 5010 format.

Here Is A Clip From A Recent Webinar Explaining The Problem And What You Can Do About It

video play - no print image support

Electronic Claims Video – Create Shortcut for Explanations Of Loop And Segment Rejections

Don’t Have All Those Loop & Segment References Memorized?  No Problem – This Might Help

When you have electronic claims rejections, the clearinghouse often includes these Loop and Segment references.  If you don’t know what these loop and segment references mean, don’t feel too badly because we don’t know what they mean either.  Luckily though there is a reference guide that can help explain.

In this short video, learn how to create a desktop shortcut for yourself so that you can quickly access the information and look up these references.  This way the explanations you are looking for are now at your fingertips.

Watch the video here…

video thumbnail - loop and segments shortcut

 Video Transcript:

In this video we’re going to show you how to set up a shortcut on your desktop that’s going to explain what all those loop and segments are. So when you get a rejection in Revenue Management or from your clearing else or even from the insurance company. Most of the time they’re going to include that was a rejected for a certain loop and segment number. This is going to help you make heads or tails and how to actually fix it.

First thing we want to do is on the desktop we go to an empty spot where there are no icons and right click and choose New, Shortcut, and then we’re going to browse into this PC. We’re going to go to our Medisoft folder and the Bin, and we’re going to scroll down until we get to that one file. It’s one of those files that’s kind of hard to find unless you know what you’re looking for. We’re going to look for MedisoftHelpAIIANSI. Then we click on next, we’re going to name this just to make it easier, Loops and click finish. There’s our desktop shortcut to those loop and segments.

When we get a rejection and let’s say that it was going to be on loop, here we go let’s just go click one out of random, Loop 2000B Segment HL. We click on that and it’s going to tell you everything about where that loop and segment is. If it’s right here, if it’s loop and segment HL01 it tells you all that stuff. The most common one is 2010AB Pay-to Provider Name, it tells you here again where it all is. If it’s Loop2010AB Segment N2 tells you right here, segments not used; For segment N3 it tells you where it’s point from practice information.

Same here if it was rejected because of Loop2010AB Segment N3 then we’re going to know that it’s probably the Pay to Address 1 and this is where you find it, it’s going to be in the Practice information, Practice Pay To tab, Street 1. It tells you exactly where that loop and the segment is pulling from so you can repair it, re-submit the claim and get that claim paid.

Medisoft Support Video: See The Responsibility Flow For A Claim

See the progress or status of a claim at a glance in Medisoft

Medisoft Tips and Tricks

This video takes a look at the Charges Tab in Medisoft, which is where you will be able to see a summary of the responsibilities of a claim for a particular patient.  You will be able to see which parties are responsible, what the claim number is, when it was sent, and which party has paid what amounts to date.  It is a nice view of the responsibility flow of a claim in the program.

Take a look at this very quick video to get some valuable instruction on how to read and use this tab in the program.

Medisoft training video to view flow of a claim in the program

 Video Transcript:

This video we’re going to show you an easy way to look at the flow of the claim once it’s been sent.

Here we’ll look at this patient’s one line. The best way to do that is to make sure your pointer is here on the line that you want. If you have multiple lines of services make sure you click on the line that you want to look at. If you go over to the top right here where the two tabs are and click on the charges tab, this tells you the flow of what, when, and where.

It tells you here that insurance one, two, and the guarantor are responsible for the payment. It was billed out on claim 18 on 1/13/2015 to insurance one and then to insurance two. Insurance one paid 23.44, which is right here, and insurance two paid 8.66, which is right here. It shows guarantor has still not paid anything so they’re still responsible.

That’s the easy way to see what and when and where a claim line has been paid.

Sending Claims Couldn’t Be Any Easier

Sending Claims & Getting Paid is Essential- But it doesn’t have to be a PAIN!

AZCOMP’s Easy Claims™ makes it- well EASY!

Medisoft Electronic Claims

With Easy Claims™, enjoy the easy life by:

  • Getting Paid Faster
  • Having Less Rejections
  • Saving Hours of Data Entry Time
  • Improving Cash Flow
  • No Longer Wasting Time Uploading/Downloading to a Website
  • No More Dealing with Paper Claims, Paper EOBs, or Paper Secondary Claims


medisoft medical billing software


What AZCOMP’s Easy Claims Does for You:

Sends Claims Electronically straight from Medisoft or Lytec in ANSI format to our preferred ClearingHouse. No Website to upload or download to.

Scrubs Claims to check & make sure each one meets ANSI 5010 requirements. Fix Problems before you send them & Reduce Rejections

Flexible ERA (Electronic Remittance Advice) downloads directly to Medisoft/Lytec to give you complete control over which line items to post & what posting codes to use. Saves Hours of Data Entry Time.

Seamless Integration between your billing software & the ClearingHouse. Keeps ALL your claims, reports, & posted payments/adjustments nice & tidy in the program.

Eligibility Verification verify & check patient eligibility (before a service is performed) with just 3 clicks right inside Medisoft!

Faster Turnaround gets your money from the payor in the shortest time possible (generally within 4 – 10 days instead of 2 months)! And if there is a rejection you will know the next day!

medisoft medical billing software

Learn More and Sign up For AZCOMP’s Easy Claims™ Here