Onboarding Forms & Templates (Fusion) – Fusion Web Clinic

During your initial setup call, you may have discussed with your Customer Success Manager one or several forms you'll be filling out to set up your clinic. Use this article as a guide for understanding what to place in each field of a form.

Patient Data Import Form

Download Patient Data Form

The patient data import form is used to import large sets of patient information into Fusion.

IMPORTANT: When using this form, please do not edit the columns or general layout of the form. Any information you'd like to import that does not have an associated column will need to be added manually after the import is complete. Feel free to leave any columns blank that your clinic doesn't utilize.

Patient Information

Field	Description
First Name*	The patient's first name. Must be a single word with no spaces or hyphens.
Last Name*	The patient's last name. Must be a single word with no spaces or hyphens.
Middle Name	The patient's middle name. Must be a single word with no spaces or hyphens.
Nickname	The patient's nickname. Must be a single word with no spaces or hyphens.
Medical Record	Patient record number assigned by the clinic for internal use.
SSN	Patient's 9-digit social security number.
Sex	Patient's sex. Must be formatted as "Male", "Female", "M", or "F".
DOB	Patient's date of birth.

* Fields with an asterisk are required for the patient data import.

Location

Field	Description
Name*	Location where the patient received treatment. Examples: "Clinic", "Home", or "Your Clinic Name".

* Fields with an asterisk are required for the patient data import.

Contact Information

Field	Description
Name	Patient's primary contact. Must only be the primary contact's first and last name in that order.
Email	Primary contact's email address.
Address	Primary contact's preferred address.
City	Primary contact's city of residence.
State	Primary contact's state of residence.
Zip	Zip code of address listed above. Must only be 5 digits.
Phone #	Primary contact's home phone number.
Cell #	Primary contact's cell phone number.
Cell # Notes	Any important notes about reaching the primary contact. Must be 50 characters or less.
Emergency #	Patient's emergency number.
Emergency # Notes	Any important notes about reaching the primary contact. Must be 50 characters or less.

Physician

Field	Description
First Name	Physician's first name. Must be a single word with no spaces or hyphens.
Last Name	Physician's last name. Must be a single word with no spaces or hyphens.
Practice	Name of physician's practice. If the practice is listed, the physician's first and last name must also be present.
NPI	Physician's NPI. If an NPI is listed, the physician's first and last name must also be present.
Address	Address of the physician's practice.
City	City where physician's practice is located.
State	State where the physician's practice is located.
Zip	Zip code of address listed above. Must only be 5 digits.
Phone	Phone number of the physician's practice.
Fax	Fax number of the physician's practice.

Primary Coverage

TIP! When listing patient's coverages, be consistent with payer names. This will create a cleaner payer manager after the import. For example, don't list one patient's coverage as "SC Medicaid" and another's as "South Carolina Medicaid".

Field	Description
Name	The name of the patient's primary coverage.
Subscriber ID	Patient's subscriber ID as given by the payer.
Group Name	Patient's group name as given by the payer.
Group #	Patient's group number as given by the payer.

Secondary Coverage

Field	Description
Name	The name of the patient's primary coverage.
Subscriber ID	Patient's subscriber ID as given by the payer.
Group Name	Patient's group name as given by the payer.
Group #	Patient's group number as given by the payer.

Tertiary Coverage

Field	Description
Name	The name of the patient's primary coverage.
Subscriber ID	Patient's subscriber ID as given by the payer.
Group Name	Patient's group name as given by the payer.
Group #	Patient's group number as given by the payer.

User Data Import Form

Download User Data Import Form

The user data import form is used to import large sets of users into Fusion.

User Information

Field	Description
First Name*	User's first name. Must be a single word with no spaces or hyphens.
Last Name*	User's last name. Must be a single word with no spaces or hyphens.
Email*	User's email address used to login to Fusion.
License	Therapist's license number as it should appear on documentation.
Credentials	Therapist's credentials as it should appear on documentation.
NPI	The National Provider Identifier assigned to a therapist.
Service	Therapist's service type. Must be formatted as OT, PT, ST, VT, PS, TH, or CM.
Signoff	Determines if a user can sign off on their own documentation without the need for a co-signer. Must be formatted as "Yes", "No", "Y", or "N".
Self-Schedule	Determines if a user is able to schedule appointments for themselves. Must be formatted as "Yes", "No", "Y", or "N".

* Fields with an asterisk are required for the user data import.

Role

Field	Description
Name	Determines what permissions a user will have. Common examples would be "Scheduler", "Therapist", "Biller", or "Admin".

Payer Enrollment Template

The Payer Enrollment Template is used to set your clinic up for billing. Your Customer Success Manager will use this information to set you up with our third-party clearinghouse and begin preparing your payers for claim submission.

IMPORTANT: Use the Payer Enrollment Template to set up payers if you are on Fusion's Billing plan.

Complete and Submit the Payer Enrollment Template

Your Email Address: Enter the email address where you would like to receive emailed communications from the Enrollment Team.
Subject: Enter "New Clinic EDI Enrollment."
Product: Select "Fusion."
Primary/Corporate Site Name: Enter the organization name as it would appear in box 33 of the 1500 form.
Site Address, City, State & Zip Code: Enter the address as it would appear in box 33 of the 1500 form.
Site Email Address (optional): Leave this field blank.
Phone Number (optional): Leave this field blank.
Fax Number: Leave this field blank.
Location NPI (optional): Leave this field blank.
Do you have Multiple Locations with Multiple NPIs (optional): Leave this field blank.
NPI: Enter the billing NPI you will be using for claims. This is usually the organization NPI.
Payor: Enter the payer name of a payer you will be billing.
Payor ID: Enter the Payer ID for the payer listed above. This should be a five digit number, but may also be letters or a combination of letters and numbers. The Payor ID is usually located on a patient's insurance card or the payer's website. You can also contact the payer.
Payor Type: Choose a payer type. Once you select a payer type, an additional payer slot will open for subsequent payers.
Are you a New Customer?: Select "Yes" if you are an onboarding clinic. If you select Yes, you will be prompted to enter your Project Manager's name in an additional field.
Project Manager Name: Enter the project manager's name. This alerts the enrollments team and is required for new customers.
Tax ID: Enter the clinic's tax identification number.
Taxonomy Number (optional): Enter the billing taxonomy number.
Billing NPI ID: Enter your organization NPI, or enter your individual NPI if you are billing as an individual.
How Many Individual NPI IDs (optional): You can leave this blank if you are submitting claims as an organization.
Group NPI (optional): Enter the organization NPI.
Description: Enter specific notes or questions for the enrollment team. For example, if you bill all payers as the organization, expect for payer that you bill as an individual, notate how you will bill that payer here.
Attachments: (optional): You have the open to attach a file. This is not usually necessary.
Click the Submit button to send the Payer Enrollment Template to the enrollments team.