Overview
The Payer: New and Payer: [name] pages are comprised of five tabs:
The Provider IDs tab collects the unique identification numbers issued by the payer to providers. Use the Provider IDs tab to record identification numbers issued by the payer to each provider whether the provider participates with the payer or not. Provider participations and identification numbers recorded at the payer are inherited by its plans, but can be overridden at the plan.
(Click an image below to enlarge.)
Payer: New Page / Provider IDs Tab
Payer: [name] Page / Provider IDs Tab
Field Definitions
Field | Type | Required | Description |
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Provider ID Type | Filter | Yes | Specifies whether provider identification numbers are issued for general use or for facility-specific use. Options include:
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Practice | Filter | Yes | The list of the practices to which providers are affiliated. |
Find | Search | No | Filter for locating a provider. The provider name or identification number can be entered. The values entered are matched to the items in the list as you type. |
Hide Expired | Checkbox | No | If checked, hides the providers who are not currently active. If not checked, both active and inactive providers are displayed. |
Provider Name | Display Only (Pulled from created/updated Providers) | Yes | The name of the provider. By default, the provider name is listed by last name, first name in ascending order. |
PAR | Checkbox | No | Indicates whether the provider participates in the payer or plan as a network provider. If checked, the provider is PARticipating. Use the effective and expiration dates to manage the status of PARticipating and non-PARticipating providers.
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Accepts Assign | Checkbox | No | Indicates whether the provider can receive reimbursement directly from the payer or plan on behalf of the patient, and that the provider accepts the contractual amount for reimbursement. If PAR is selected, the Accepts Assign option is automatically selected.
If the PAR option is cleared, the Accepts Assign can be selected independently. Select this option if the patient has given the provider permission to accept payment from the payer or plan on the behalf of the patient; otherwise leave blank. |
Effective | Date (mm/dd/yyyy) | Yes (for PAR provider) | The date the provider begins accepting the insurance of the payer or plan as either a non-PARticipating or a PARticipating provider. For a PAR provider, this date is required. |
Expiration | Date (mm/dd/yyyy) | No | The date the provider no longer participates in the payer or plan, or the day before a non-PARticipating provider goes to a PARticipating provider. Typically, this date is the expiration date of the payer or plan contract. Use the effective and expiration dates to manage the status of PARticipating and non-PARticipating providers.
For example, the provider starts participating on 03/01/2016. Enter 02/29/2016 as the expiration date in the existing row, then click Add to add a new row. In the new row, select the PAR checkbox, and then enter 03/01/2012 as the effective date, and the provider identification number in the appropriate columns. |
Suspend Claims | Checkbox | No | Indicates claims will not be generated for a particular provider. If checked, all claims submitted from a provider are suspended. If charges are entered for the provider in Connect Back Office, an error displays during the error checking process, and no claims are generated for the provider. |
Contract Code | Free Text | No | Specifies the contract code for the payer or plan. For Medicaid OK, type the applicable contract code in this column to include this code in the 2300 loop, CN1 segment of the electronic claim. |
Provider ID | No | The general identification number issued to the provider by the payer or plan. This column only appears if the Provider ID Type is set to General Provider ID. | |
Facility Provider IDs | No | The facility identification number issued to the provider by the payer or plan. This column only appears if the Provider ID Type is set to Facility-Specific. The field may contain multiple Provider IDs if there are multiple facilities. To populate/update the field:
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Button Descriptions
Button | Shortcut Keys | Description | Step-By-Step Guides |
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Add | Add a new row under the existing provider to update the effective and expiration dates of a PAR provider or add a non-PAR provider that is now PAR. |
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Clear ID | [Alt] + [I] | Remove the effective and expiration dates and the provider identification number. |
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