Payer Billing Options

General Billing Options Tab

Follow the steps below to view and edit the billing options for payers.

  1. Select Customer Setup > Payers.

  2. Use the Show All button to view all payers. Or use the Search field to further drill down your search.

  3. Select the Payer.

  4. Click the Billing Options tab from the side panel. 

  5. Make your selections by referencing the Billing Option Descriptions below.

  6. Use the to the default the POS (Place of Service) Code to be used on claims for this payer.

  7. Automatically set Claim Follow-Up dates: Check this box to have the system automatically enter a claim follow up date based on the payer.

    • Important things to know:

      • If you specify to have the claim follow-up 0 days after the claim was submitted, no automatic follow-up date will be set.

      • The date will populate when any of the following actions are taken:

        • The claim is printed from the Claim section, Payment section, or Batch Printing tab.

        • The claim is sent electronically. 

      • The follow-up date WILL get overridden if the claim is re-submitted or send to a secondary/tertiary payer. 

      • The follow-up date WILL be overridden if you manually enter a date BEFORE the claim is actually submitted/printed.

  8. Use the provider name as the pay-to name: Check this box to only send the provider name vs the practice name as the pay to name.

  9. Only send the pay-to address: Check this box to only send the pay-to address.

  10. Use the office address as the pay-to address: Check this box to print the Office Location/Other Offices address selected within the claim section to print in box 33.

  11. Print CMS-1500 as NY Workers Compensation Form: Check this box to print claims as the Workers Compensation form.

  12. Override billing provider with rendering provider: Check this box if you would like claims to be billed under the Rendering Provider selected on the claim.

  13. Professional Options

    1. Default POS: Select which Place Of Service code that should be used when billing claims to this payer.

    2. Do NOT print the payer address on the top of the form: Check this box if you do not want the payer address printed on the top of the CMS-1500 claim form.

    3. Exclude patient payments from Box 29: Check this box if you do not want to include any patients payments on the CMS-1500 claim form in box 29.

    4. Print the license number in Box 31: Check this box if you wish to include the license number in box 31 of the CMS-1500 claim form.

    5. Print the following in Box 31: Use the drop-down menu to select whether to use the Provider Name, Practice Name or the Signature on File for box 31 of the CMS-1500 form.

    6. Remove the insured’s ID# from Box1A: Check this box to remove the insured’s ID# from box 1A of the CMS-1500 claim form.

    7. Print the following supplemental info in Box 24: Use the drop-down menu to select to use either the Narrative Notes or the Anesthesia Start/Stop Time in box 24 of the CMS-1500 claim form.

    8. Print ICD codes in Box 24E: Check this box if you would like to print the ICD codes in box 24E on the CMS-1500 claim form. 

    9. Send minutes instead of units on anesthesia claims: Check this box if you would like to use minutes instead of units for anesthesia procedures.

    10. Send anesthesia start/stop times in a line note: Check this box if you would like to include the anesthesia start and stop times as a line note on the CMS-1500 claim form.

  1. Institutional Options

    1. Print the following in Box 38: Use the drop-down menu to select whether to use the Insured's address, Payer’s address or to leave Box 38 blank on the UB-04 claim form.

    2. Print the following in Box 80: Use the drop-down menu to select whether to use the Insured's address, Payer’s address or the remarks for Box 80 blank on the UB-04 claim form.

    3. Print referring physician in Box 76: Check this box if you would like to include the referring provider in box 79 of the UB-4 claim form.

  2. Click Save. Or proceed to the Provider tab of Billing Options


Provider Billing Options Tab

The provider billing options allow you to customize certain configuration settings for one or more providers specific to this payer. Providers not listed below will bill claims based on their general settings/configuration in the provider screen.

  1. Select Customer Setup > Payers.

  2. Use the Show All button to view all payers. Or use the Search field to further drill down your search.

  3. Select the Payer.

  4. Click the Billing Options tab from the side panel. 

  5. Make your selections by referencing the Billing Option Descriptions below. 

  6. Use the Provider(s) drop-down menu find the provider you would like to find.

  7. Use the Status drop-down menu to select whether or not this provider is active with this particular payer.

  8. Use the Bill Mode drop-down menu to select whether this provider should bill to this payer as an individual or as a group. 

  9. Add the ID to use if the Bill Mode is set as Individual in the Individual ID field. 

  10. Add the ID to use if the Bill Mode is set as Group in the Group ID field. 

  11. Use the Accept this Insurance checkbox to select whether or not this provider accepts this insurance. This indicates if the Provider accepts assignment.

  12. Click Add once you are satisfied with your changes. These settings can be edited after saving by clicking on the field you wish to edit.

  13. Click the icon to copy these settings to all providers added to this payer.

  14. Check the Show separate configurations for each office location if you would like to configure these settings differently for each office associated to your account.   

  15. Click Save. Or proceed to the General tab of Billing Options