Payers are the insurance companies that are used to bill electronic and paper claims to for reimbursement of services provided. The Payer Search screen can be accessed by opening the Setup portal and clicking on Payers under Billing Setup. A user can then search for a payer and open the Payer Setup screen. The Payer Setup screen can be used to:
Edit Existing Payers
Configure Claim Submission settings
Payer Window Buttons
- New: Clicking the New button allows the user to Add a New Payer
- More: Clicking the More button gives the user the options to view Clearinghouse Payers, open the Advanced Search Screen, set Order Routes, configure Lab Bill Codes, set Payer ERA overrides, or Remove Unused Payers
- Search (Magnifying Glass): Clicking the Search button opens a search box to allow the user to search for and open a specific payer
Payer Setup Screen
The Payer Setup Screen opens to the Summary tab. The Summary allows you to see all of the settings quickly that have been configured on the other tabs. You can switch to the other tabs by clicking on the section of the summary you wish to go to or by clicking on the tab name on the left side.
The Demographics tab allows the user to enter address information specific to the practice. In addition the financial class, reporting class, and active indicator are all found here as well.
The Contacts tab allows the user to store a primary and secondary contact for the payer.
The Submission tab allows the user to customize settings that will be used in both electronic and paper claims. Here you enter the payer id for the clearinghouse, define how primary/secondary claims will be billed, set the Source of Pay, etc. In addition secondary identifiers can be turned on as deemed necessary by the payers. In the flags section the user will find several boxes that must be turned on for billing (Billable, Use NPI) as well as option to turn on Auto-Post ERAs for the payer.
The Electronic (837) tab allows the user to configure settings specific to electronic claims.
The Paper (CMS) tab allows the user the configure settings specific to paper (printed) claims.
The Authorization tab allows the user to set authorization requirements and set an Alternate Payer Name.
The Eligibility tab allows the user to disable eligibility checks, set a payer id to be used only for eligibility checks, and to set the NPI location by payer.