What this section is for

The Payers section is where you enter the patient's insurance information. A payer is the insurance company or government program that will pay the claim. Many patients have more than one type of insurance, so you can add multiple payers.

Adding a payer

  1. Click Add Payer in the Payers section header.
  2. The payer window opens with two tabs: Payer and Subscriber. If the patient already has insurance on file, click Use this insurance to fill everything in at once. Otherwise use Payer (search by name or ID) to find the insurance company. The search covers the shared payer directory.
  3. Pick the Payer Responsibility - P - Primary, S - Secondary, T - Tertiary, or A - Payer Responsibility Four (shown as Additional on the payer card).
  4. Enter the Policy ID - the policy or member number printed on the patient's insurance card.
  5. Enter the Group ID if one is listed on the card.
  6. On the Subscriber tab, fill in the subscriber information - this is the person who holds the insurance policy. It might be the patient, or it might be a spouse or parent.
  7. Click Save. The payer appears as a card in the Payers section. (Cancel closes without keeping changes; Delete removes the payer from the claim.)

Self-pay and paper payers

Two checkboxes on the Payer tab change how the claim goes out. Patient / Self-Pay is for billing the patient directly instead of an insurance company; the balance is collected through patient statements. Paper Claim keeps the payer on the claim but excludes it from electronic submission so you can download and mail a CMS-1500 instead. Paper Claim is also the way to bill a payer your clearinghouse cannot reach electronically.

Primary and secondary payers

Each payer card shows its responsibility as a blue badge: Primary, Secondary, Tertiary, or Additional. The primary payer gets the claim first. After the primary payer processes the claim, you may send the remaining balance to the secondary payer.

Editing a payer

Click anywhere on a payer card to reopen the window and change any field.

Tips

  • Always copy the Policy ID exactly from the insurance card, including any letters or dashes.
  • If you cannot find the payer in the search, ask your administrator to add it in Settings first. See Managing payers.
  • Double-check that the subscriber information is correct. If the patient is a child, the subscriber is usually a parent.
  • After adding the primary payer, use the eligibility check button below the payer cards to confirm the coverage is active. See Checking eligibility.