Configuring Payers

Use this task to configure payers for the plans to which you will submit claims. Payers have a parent/child relationship with their plans. Each payer must have at least one plan. Use the payer configuration as a means to group various plans that have similar requirements, for example, Medicare, Medicaid, or Commercial, then specify the individual plans of various payers under the appropriate payer configuration.

The payer configuration includes the coverage and insurance types and identification numbers issued by the payer to providers, referring physicians, facilities, and groups. The identification numbers entered in the payer configuration are the same identification numbers for all plans linked to that payer. Typically, the identification numbers are entered for all plans or for a majority of the plans in the payer configuration, so they do not have to be duplicated in the plan configuration. However, if a plan requires different identification numbers than the other plans for that payer, it can be entered in the plan configuration for that specific plan. For example, a plan uses the same identification numbers for facilities and groups as the other plans, but different provider identification numbers. All identification numbers can be entered in the payer configuration, and then only the provider identification numbers are entered for that plan in the plan configuration.

The payer configuration includes information collected on the following tabs:

Step-By-Step Guide

Step	Instructions	Additional Information
1	General Tab From the Payers & Plans page, click Create Payer. The Payer: New page opens with the General tab displayed.
2	In the General section, enter the name of the payer in the Payer Name field.
3	Enter additional information to describe the payer in the Description field.
4	Open the Coverage Type drop down list and select the number format that you want to use for claim generation.
5	Open the Insurance Type drop down list and select the option for the type of insurance the payer provides.
6	In the Linked Plans section: Add a new plan to the payer by clicking Create.	Plans can also be added later via an update to the payer. In order to add a plan and enable the Create button in the Linked Plans section, the new payer record must first be saved or applied.
7	Click Apply.
8	Provider IDs Tab Click the Provider IDs tab to record the general provider identification numbers issued by the payer.
9	Open the Provider ID Type drop down list and select General Provider ID.	To record the facility-specific provider identification numbers issued by the payer, select Facility-Specific from the Provider ID Type drop down list.
10	Open the Practice drop down list and select the practice.
11	If adding a PAR provider: Select the PAR checkbox to indicate the provider participates with the payer. Enter or select the effective date in the Effective column. Enter the identification number issued to the provider by the payer in the Provider ID column. If adding a non-PAR provider: Enter or select the effective date in the Effective column. Enter the identification number issued to the provider by the payer in the Provider ID column.	A checkmark appears in the Accepts Assign checkbox, indicating that the provider can accept reimbursement on behalf of patient directly from the payer. Remove the checkmark if the provider does not accept assignment of reimbursement. If entering facility-specific provider ID numbers, enter the identification number in the Facility Provider IDs field.
12	Select the Suspend Claims checkbox to stop generating claims for the selected provider.
13	Enter the contract code for the selected payer in the Contract Code field.
14	Repeat the above steps for each provider you want to add identification numbers.
15	Click Apply.
16	Referring Physician IDs Tab Click the Referring Physician IDs tab to record referring physician identification numbers issued by the payer.
17	Select the Payer issues referring physician IDs checkbox to indicate this payer issues identification numbers to referring physicians.
18	Enter the identification number of the referring physician in the ID Number field of the selected provider.	Utilize the Find search to quickly locate a provider. The list of providers displayed updates real-time as the search criteria is entered.
19	Repeat the above steps for each referring physician you want to add identification numbers.
20	Click Apply.
21	Facility IDs Tab Click the Facility IDs tab to record the general facility identification numbers issued by the payer.
22	Open the Facility ID Type drop down list and select General Facility ID. The table refreshes with Facility Name and ID Number.	To record the Place of Service specific facility identification numbers issued by the payer, select Place of Service Specific from the Facility ID Type drop down list. The table refreshes with Place of Service and ID Number.
23	Enter the identification number issued to the provider by the payer in the ID Number column.	If entering Place of Service specific facility ID numbers, a Facility field is also available. Open the Facility drop down list to select the facility to update the list of Places of Services displayed.
24	Repeat the above steps for each facility or place of service you want to add identification numbers.
25	Click Apply.
26	Group IDs Tab Click the Group IDs tab to record or modify the general or facility-specific group identification numbers issued by the payer.
27	Open the Group ID Type drop down list and select General Group ID. The table refreshes with Practice Name, Physician Group, PA Group, CRNA Group, and AA Group.	To record the facility-specific identification numbers issued by the payer for each provider group, select Facility-Specific from the Facility ID Type drop down list. The table refreshes with Practice Name, Physician Group, PA Group, CRNA Group, and AA Group.
28	Enter the identification numbers for the following provider groups in the respective column: Physician Group PA Group CRNA Group AA Group
29	Repeat the above steps for each practice or facility you want to record group provider identification numbers.
30	Click Save to save and close the page.

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