Payers Section Overview
The Payers section allows you to manage insurance providers (payers) and their details for accurate billing and streamlined communication.
Adding a New Insurance Provider
2. Click the gear icon.
3. Click "Payers"
4. Click "+ Insurance Provider"
5. Add the Payer Name: The displayed name in the system (e.g., Blue Cross Blue Shield, Aetna).
6. Find the Payer ID
Payer ID: Essential for syncing with the clearinghouse.
7. Select Payer Typer
Payer Type: Helps categorize payers for reporting purposes (e.g., commercial vs. government payers).
Key Features and Fields
8. If applicable, add a payer alert.
Payer Alerts: Customizable notes visible to providers. Examples:
Billing rules (e.g., "Only bill 4 units").
Helps guide providers during note-writing for accurate billing.
9. Add payer address.
10. Add payer contact information.
Contact Information: Include address, fax, and email for streamlined communication and document submission.
11. Select a network status.
Network Status:
Marks payers as in-network or out-of-network.
Displays status in the calendar and other areas to inform staff about benefit requirements.
12. Select a charge / unit calculation methodology.
Eight-Minute Rule: Automates unit calculations based on CMS’s eight-minute rule or AMA Rule of Eight.
13. Activate this payer
Active vs. Inactive Status:
Active: Available for selection by staff and patients.
Inactive: Removed from selectable options.
14. Indicate if this payer requires plane of care certification
15. Click Save.
