Payer Filing Setup

To setup payers/insurance companies, select the Lists menu, and then select Payers.  In the upper right corner of the screen, click the Edit or New button.

Click here for more up-to-date information on Filing Setup

The Payer edit screen is broken into 3 sections.

1. Payer Information

2. Filing Setup

3. Electronic Filing Information

CMS Form Information	Field	Notes
Insured Policy Number 1. Show this field 2. Leave this field blank	Box 11	Retrieved from patient demographics screen
Insured DOB / Sex 1. Show this field 2. Leave this field blank	Box 11a	Retrieved from patient demographics screen
Employers Name 1. Show this field 2. Leave this field blank	Box 11b	Retrieved from patient demographics screen
Insurance Plan Name 1. Show this field 2. Leave this field blank	Box 11c	Name of payer
Another Health Plan 1. Show this field 2. Leave this field blank	Box 11d	Yes is checked if a secondary payer exists
Date of Current 1. Show this field 2. Leave this field blank	Box 14	Retrieved from Claims screen
Referring NPI 1. Not required 2. Required	Box 17b
Referring Provider ID – options are: 1. None 2. Referring UPIN 3. Referring Taxonomy Code 4. Referring PIN	Box 17a	See note below for qualifiers
Claim Notes 1. Manual Entry 2. Show Provider Taxonomy Code	Box 19	Claim notes are entered manually when creating claims
Prior Authorization Number  – options are: 1. Leave this field blank 2. Patient Precertification 3. Practice CLIA	Box 23	The data for box 23 is saved with each claim.
1^st Service Line Identifier – options are: 1. Leave this field blank 2. Show Rendering Provider PIN 3. Show Rendering Provider State License Number 4. Show Billing Provider NPI 5. Show Rendering Provider NPI*	Box 24j
2^nd Service Line Identifier – options are: 1. None 2. Provider Legacy Pin 3. Provider State License Number 4. Provider UPIN 5. Provider Taxonomy Code	Box24j (shaded)
Federal Tax ID – options are: 1. Provider EIN 2. Provider SSN	Box 25
Amount Paid 1. Show this field 2. Leave this field blank	Box 29
Balance Due 1. Show this field 2. Leave this field blank	Box 30
Signature of Physician 1. Show this field 2. Leave this field blank	Box 31
Facility Name / Address 1. Show Facility Name Address 2. Leave this field blank	Box 32
Facility NPI 1. Show Facility NPI 2. Leave this field blank	Box 32a
Facility Secondary ID 1. Show Facility Secondary ID 2. Leave this field blank	Box 32b
Billing Provider Information – options are: 1. Leave this field blank 2. Practice Name/Address 3. Facility Name/Address 4. Rendering Provider Name/Address	Box 33
1^st Billing Provider Identifier – options are: 1. Leave this field blank 2. Show Provider Legacy Pin 3. Show Rendering Provider State License Number 4. Show Rendering Provider NPI 5. Show Billing Provider NPI * 6. Show Facility NPI	Box33a
2^nd Billing Provider Identifier – options are: 1. Leave this field blank 2. Provider Legacy Pin 3. Provider Legacy Group 4. Provider State License. 5. Facility Secondary ID 6. Provider UPIN 7. Provider Taxonomy Code	Box 33b**
Payer Name / Address 1. Show this field 2. Leave this field blank	Upper Right corner of claim screen

Qualifiers for 17a, Box 24j (shaded) and box 33b are:

1B           Blue Cross

1C           Medicare

1D           Medicaid

G2          Other

0B           State License Number

1G          UPIN

ZZ           Taxonomy Code

These qualifiers are entered automatically based on the type of information that is displayed and the type of insurance carrier.  To set the type of insurance refer to the insurance information screen.

** Box 33B will contain the Payer other ID number if the Type of Service code entered on the claim is ‘9’ (other medical).  For this condition, the payer ‘other ID number’ should contain the proper qualifier as the first 2 characters of the ID number.   The payer ‘other ID number’ is entered on the insurance information screen.