Use this task to modify the payer configuration, including the identification numbers for providers, referring physicians, facilities, and groups.
The payer configuration includes information collected on the following tabs:
Step | Instructions | Additional Information | ||
---|---|---|---|---|
1 | From the Payers & Plans page, select the payer to be modified. | |||
2 | General Tab Click Update. The Payer: [name] page opens with the General tab displayed. Update the relevant information via the applicable steps below... | |||
3 | In the General section, enter the name of the payer in the Payer Name field. | |||
4 | Enter additional information to describe the payer in the Description field. | |||
5 | Open the Coverage Type drop down list and select the number format that you want to use for claim generation. | |||
6 | Open the Insurance Type drop down list and select the option for the type of insurance the payer provides. | |||
7 | In the Linked Plans section:
| |||
8 | Click Apply. | |||
9 | Provider IDs Tab Click the Provider IDs tab to record the general provider identification numbers issued by the payer. | |||
10 | Open the Provider ID Type drop down list and select General Provider ID. |
| ||
11 | Open the Practice drop down list and select the practice. | |||
12 | If adding a PAR provider:
If renewing a PAR provider:
If changing a PAR provider to non-PAR status:
If adding a non-PAR provider:
If changing a non-PAR provider to PAR status:
|
| ||
13 | Select the Suspend Claims checkbox to stop generating claims for the selected provider. | |||
14 | Enter the contract code for the selected payer in the Contract Code field. | |||
15 | Repeat the above steps for each provider you want to add identification numbers. | |||
16 | Click Apply. | |||
17 | Referring Physician IDs Tab Click the Referring Physician IDs tab to record referring physician identification numbers issued by the payer. | |||
18 | Select the Payer issues referring physician IDs checkbox to indicate this payer issues identification numbers to referring physicians. | |||
19 | Enter the identification number of the referring physician in the ID Number field of the selected provider. |
| ||
20 | Repeat the above steps for each referring physician you want to add identification numbers. | |||
21 | Click Apply. | |||
22 | Facility IDs Tab Click the Facility IDs tab to record the general facility identification numbers issued by the payer. | |||
23 | Open the Facility ID Type drop down list and select General Facility ID. The table refreshes with Facility Name and ID Number. |
| ||
24 | Enter the identification number issued to the provider by the payer in the ID Number column. |
| ||
25 | Repeat the above steps for each facility or place of service you want to add identification numbers. | |||
26 | Click Apply. | |||
27 | Group IDs Tab Click the Group IDs tab to record or modify the general or facility-specific group identification numbers issued by the payer. | |||
28 | 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. |
| ||
29 | Enter the identification numbers for the following provider groups in the respective column:
| |||
30 | Repeat the above steps for each practice or facility you want to record group provider identification numbers. | |||
31 | Click Save to save and close the page. |
Not applicable for this topic |