Payer is used to setup insurance company pricing and guarantor or patient self payment. If you are paying through a clearinghouse, Enabledoc will work with you to ensure that the payer IDs are correct for the selected clearinghouse.
Adding and Editing Payers Adding a new payer is performed by clicking the New button and filling in each field. To edit a payer, select the payer from the pull down menu. Fill in any of the following fields that apply:
Name: This is the name of the payer that will appear on the HCFA Form or is sent to the insurer via a clearinghouse.
Short name: This is the shortened name for the payer.
Address 1: This is the first line of a payer’s address. This line is not required.
Address 2: This is the second line of a payer’s address. This line is not required.
Country: Must select the country first.
State: Then select the state for the payer.
Zip: Then select the zip for the payer.
Billing Address 1: This is the first line of a payer’s billing address. This line is not required.
Billing Address 2: This is the second line of a payer’s billing address. This line is not required.
Payment Collection Address 1: This is the first line of a payer’s collection address. This line is not required.
Payment Collection Address 2: This is the second line of a payer’s collection address. This line is not required.
Parent Payer: If this payer is the same as a parent company, select the parent company from the list.
Insurance Plan Type: This field is used to set the insurance plan type at the top of the HCFA 1500 form. The options are: Medicare, Medicaid, Champus, Champva, Group Health Plan, Black Lung, and Other.
Payer ID: This is the Id used by the clearinghouse to route the insurance claim. This must be entered for electronic claims processing.
Under Insurance, Is Insurance payer, None: If the payer is under a parent, select that option. If the payer is an insurance company, then select that payer. If the company is not an insurer, then select none.
Default Payer: This sets the payer as your default payer. If a CPT price does not appear on a price list for a payer, this payer’s price list will be used.
Contact Name: Contact person at the insurer.
Standard Price: Click this button to assign the payer to a payer pricing that already exists. The following dialog box opens:
Click on a Tariff (existing payer pricing), Click the effective tariff date, and click select next to each facility to apply it to. When done, click the Save Button and the dialog closes.
Custom Price: Click this button to set a custom price for this payer or copy pricing from another payer and increase or decrease the prices. The following dialog box opens:
New Tariff allows an effective date for pricing to be set. Select a facility pricing. The option of blank tariff means that prices are entered under the Pricing and E&M Pricing screens. Copy from company allows an existing payer to be selected and copy that pricing. The pricing for a facility and effective date pricing must be selected to copy from. The prices for the selected payer can be copied and increased or decreased by an entered percentage. Click the Save Button to enter pricing for this payer or copy the payer prices to this new payer. All prices for this payer and facility are then managed under Pricing and E&M Pricing.
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