Insurance Options in AllMed PM

Insurance Options in AllMed PM

CMS-1500 & UB-04 Claim Controls (Complete Reference)

AllMed PM provides insurance-level configuration options that control how claims print, transmit electronically, and comply with payer-specific requirements. These settings are one of the most powerful — and least documented — areas of the system.

They are designed to solve real-world insurance problems without forcing workarounds, duplicate claims, or clearinghouse changes.


Where These Options Live

Top Navigation → Set Up → Insurance → Options

There are two sections:

  • CMS-1500 (professional claims)

  • UB-04 (facility claims)

Each insurance company can have its own unique configuration.


When You Should Use Insurance Options

You’ll typically adjust Insurance Options when:

  • An insurance company requests a specific box, loop, or qualifier

  • Claims reject with vague instructions like:

    • “Use SBR09”

    • “Suppress rendering provider”

    • “Only send first diagnosis pointer”

  • You need payer-specific formatting differences

  • Paper and electronic claims require different behavior

  • Medicare, Medicaid, or Blue Cross enforces strict rules

⚠️ Important:
Only change these options when instructed by the payer. These are precision controls — not defaults.


CMS-1500 Insurance Options

Location: Set Up → Insurance → Options → CMS-1500

These options affect paper CMS-1500 forms and ANSI 837 professional claims.


General Claim Formatting

  • Modifiers Defaults (Primary / Secondary)

  • Start Claim ID With

  • Only Print 1st Pointer

  • Box 31 Blank

  • Print Payments on 1500 Form

  • Birthday Format: Year 4 Digits

  • Field 11 Blank

  • 11a, 11b, 11c and 11d Blank

  • Print Primary ID in Box 11

  • Print Referring ID in Box 23

  • Print This ID in Box 26

  • Print User Name in Box 31

  • Print Y Instead of X in Box 27


Provider, Facility, and Taxonomy Controls

  • Do Not Print NPI in Box 24J

  • Do Not Print Rendering Tax ID

  • Do Not Print Taxonomy Code

  • Print Taxonomy in 24J

  • Print Taxonomy in Billing Loop

  • Print Taxonomy in 33B

  • Do Not Print Provider in Box 31

  • Do Not Print Facility

  • Do Not Print Rendering Provider

  • Do Not Print Qualifier in 33B


Diagnosis, Units, and POS Handling

  • Add POS in SV1-05

  • Include Patient Address in Box 32 When POS Is 12

  • Do Not Print Decimal Point in DX on 1500 Form


Insurance & Subscriber Rules

  • Remove Slash (/) From Patient Account #

  • Include Insurance Address in 2330B

  • Do Not Print Insured Demographics

  • Do Not Print Insured Address

  • Print Insured Address in Care Of Insurance

  • Do Not Include SBR02 When Patient Is Not the Subscriber

  • Use Insurance ID Type for SBR09

  • Print SSN in ANSI


Secondary / Special Situations

  • Do Not Print Secondary

  • Include State When Condition = Employment (Worker’s Comp)

  • Leave Top Name / Address Blank

  • Print NDC in Box 24D


UB-04 Insurance Options

Location: Set Up → Insurance → Options → UB-04

These options apply to facility billing and control how data prints in specific UB-04 form locators.


Form Locator 81CC

Used for additional code qualifiers and values required by certain payers.

  • A (Qualifier + Value)

  • B (Qualifier + Value)

  • C (Qualifier + Value)

  • D (Qualifier + Value)

Each row allows you to:

  • Select a qualifier

  • Enter the corresponding value


Admission Information (Form Locators 13, 14, 15)

These fields control admission-related data:

  • Admission Hour

  • Type

  • Admit Source

Required primarily for:

  • Inpatient

  • Facility-based billing

  • Certain Medicare and Medicaid claims


UB-04 Print Options

These settings control what prints on the UB-04:

  • Print Insurance Address in Box 80

  • Print Insurance Address in Box 38

  • Print Payor ID in Box 51

  • Print Patient Name in Box 8B


UB-04 Totals

  • UB-04: Total on Line 15

Controls where totals print on the UB-04 form when required by the payer.


How to Use This Article

If an insurance company says:

  • “Put the Payor ID in Box 51”

  • “Use Form Locator 81 with qualifier A”

  • “Do not print insured demographics”

  • “Use SBR09 based on insurance type”

  • “Suppress rendering provider”

You can:

  1. Search this article

  2. Find the option name

  3. Go to Set Up → Insurance → Options

  4. Apply the change only to that insurance


Why This Is a Hidden Gem in AllMed PM

Most systems hard-code these rules or hide them entirely.

AllMed PM gives you:

  • payer-specific control

  • transparent configuration

  • no rebuilding of claims

  • no vendor intervention

That flexibility is intentional.


Key Takeaway

Insurance Options are not defaults — they are solutions.

If a claim rejects and the insurance gives cryptic instructions, this is the first place you should look.