Home Forums Discussions General Discussion migrating insurance demographic data in 6.5.4

hi all,
I upgraded to 6.5.4 beta this week. one unexpected issue that I could use some help with is related to the new "codified" insurance database (with specific payer ID's included). I believe this will be helpful in the long run to perform future integration with PM partner and to limit the ad hoc created names/address list in demographics/insurance lists from prior versions. however, as we make this transition, i'd like to get off to a good start. this may be more of a practice management question than a technical one for those that have experience with "migrating" their insurance data.
so now with upgrade, all my prior insurance data in demo is "unmigrated" and therefore unusable for now, the unmigrated insurance field has names such as generic "Blue Cross Blue Shield" waiting to be codified. selecting the correct specific plan/payer id to match is more challenging than we thought:
- the payer id is not usually available on pt insurance card. when it is, sometimes has extra digits which the insurance company doesn't even know what they are for.
(by the way, for those not used to using payer id data I googled and found lists of over 20,000 payer id's out there!)

- sometimes we find the payer id that matches card or information from insurance company after lengthy phone call but the corresponding address on AC default list does not match card/phone rep info. we are able to enter (as administrator) to modify the specific plans to choose from (ie, change the specific name or the address or other data and keep payer id), however, I am concerned that I may be going back to creating multiple adhoc insurance choices on the list as before and will continually have to verify each one as we go.

I spoke with AC support and they instructed me to create new entries and/or edit current ones on this list but I am not confident that the data we are creating will be completely accurate and user friendly as I was hoping to just select off an up to date accurate universal list rather than creating one.

additionally, we know we are "able" to migrate all prior insurance info in batches, the problem is that "Blue Cross Blue Shield" migrated as a batch to any one specific plan (TX, Illinois, FEP...) would result in massive incorrect listing after migration, so we have to look at each one by one (my assistant is at her limits with new work this will create).

how are other practices who are using this new codified list managing inconsistencies? any unexpected consequences from editing the default list? have others found inaccurate entries in the new default list? any magical insights to getting the most accurate data for each plan? and migrate old data in an efficient way (rather than one by one)?

to be clear, again, I know the technicality of "how to" migrate/modify the data already, my questions are how to do it in a thoughtful and efficient way from a practice management standpoint, thank you.

Hi Edwin,

Welcome to the forum!

That concludes my ability to help you. So, until the experts respond, I'll go out on a limb and recommend that you do the least possible. My guess is that you might have to go all through it again when you change PMs. I find it hard to believe that the new PM partner will use ACs list of carriers anymore than NewCrop using ACs list of meds, in my often wrong opinion.

In the meantime, if there is such a thing as a universal database for carriers, you might find the info you want from your clearinghouse.

The codified insurance info came from Version 7. I thought it was a godsend given all the different ways my staff spelled various insurance companies. Blue Cross was the BIG exception. (There are a few others but...) Most of your BCBS will go to your regional system. Those out of the system can be sent to the regional system and will be dealt with by them through some sort of interagency cooperation.

One of the problems I discovered was that some were BC HMO and were listed as PPO. Thus, Each one needed to be individually verified. Most of the others, we were able to migrate and it went relatively quickly.

I have been migrating insurances by patient as they come up on the schedule, or if they call in for a medication refill, etc. We only see 20-25 patients per week in the office, so it's not a huge job. I figured this would be the easiest way to do it. We use a third party billing service that is not connected to AC, so I'm not too concerned about getting it done quickly. I'm also not worried about fixing our previous hospital patients, just adding the new ones correctly. I am making a list of those insurances that I cannot find on the codified list so I can pass them on to AC support.

It might be much easier to do the batch migration for the easy ones, and just leave the difficult ones untouched.

I do a lot of medicaid. There were listings for medicad, meidcaid, idpa, healthy kids, all kids, and more. You can just say convert all medicad for example to Illinois Dept. of Healthcare & Family Services and boom, 30 or 300 persons are converted. It only took about an hour to do everyone except Blue Cross. They are still italicized so the staff knows they need to convert them when they come up.

thank you all for your replies.
we're on a hybrid approach, some in batches, some individually.
by the way, what are you all doing with uninsured patients? we previously had a dummy insurance called "selfpay" to let our billing company know, however, caused some confusion on lab slips where patients were billed directly rather than billing us at client rates. now have option to check box for "no insurance" but old patients are unmigrated as "selfpay". weighing options to eliminate that dummy insurance and use the "no insurance" checkbox (which leaves a blank on demographics/orders) or create a new fake codified "selfpay" insurance to migrate everyone to (about 1/3 of my patients).
ps, has anyone noted that if you inactivate an insurance it still shows up on orders/invoices...looks like a glitch that will need correcting.