Payer

Judy Barnes Billing, Configuration
NAVIGATION:
  1. Open Payers from Practice Management on the Main Navigation Menu
  2. To create a new record, enter the name and Insurance Type ‘Insured’ if you will file insurance claims electronically or on 1500 form.
    Non-Insured if you would bill the patient.
When setting up payers, it is best practice to use the exact name your cleaning house uses. See your clearinghouse for a list of payers and their ID# as defined by your Clearing House.
    Type in a new Payer name and click add. After clicking Add, the Payer edit screen will open. To edit an existing Payer record, click the pencil icon next.

  1. Payer Name – Use the name listed in the Clearing House DB
  2. Payer Type – Insured if claims should be printed on 1500 form or sent electronically.
  3. Insurance Type – This will determine which box at the top (BOX 1) of the 1500 form is checked on printed claims.
  4. Email ID – *Not Required* This is for office reference does not populate on printed 1500 form
  5. Address – Street address.Where printed/mailed claims would be sent to. (Box 7)
  6. City-  Populates in  (Box 7)
  7. State- Populates in  (Box 7)
  8. Zip Code– Populates in (Box 7)
  9. Telephone- Populates in (Box 7)
  10. FAX– *Not Required* This is for office reference does not populate on printed 1500 form
  11. Payer ID – Found through the clearinghouse Payer Search or list.
  12. Clearinghouse – Which clearinghouse these electronic claims should be sent to.
  13. DX Code Type – Which diagnosis codes this payer accepts (Will limit which codes provider can add to SOAP note) NOTE: After October 1, 2015 choose ICD-10 Codes.
  14. Additional Claim Info– see standard text below
  • Default Paper Claim – When checked, indicates this payer takes claims on printed CMS 1500 rather than electronically.
  • a: Taxonomy code- are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten character alphanumeric code that enables providers to identify their specialty at the claim level. If a taxonomy code is required by a payer it would show in (Box 33).
    *most chiropractic payers do not require this code
  • b: Include DTP 454 in EDI- When submitting to payer that requires loop 2300 DPT454. *Most Medicare payers require this when submitting electronically.
  • c: Include Standard Text- This will populate text into (box 19) for this specific payer. Type what would like in the “additional claim info” box
  • d:Use Rendering Provider in 33a: This option will override group and location settings for box 33a/loop
  • e: Include Accident Date in EDI – include the onset date from DOS when Visit Type ‘isAccident’ is true for payers when this option is selected- (BOX 14)
  • f: Include x-ray Date- When checked this will include x-ray date in (box 15)
  • g:Append 0000 to 5 digit zip code– ONLY Mark as true if a payer requires 9 digit zip code when only 5 numbers are entered will add 0000. Leave unchecked to use what you enter in as default for payer, patient and clinic.
  • h:Accept Assignment-When checked will mark yes in box 27 on 1500 forms and on the EDI