Payer Billing Options

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.

   Visit our Claim Defaults Priority Rules Help Article for a detailed list of the order of precedence of claim defaults.

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.

8. Optional: Copy this payer’s follow-up settings to other payers within your customer account by clicking the “Copy this follow up configuration to other payers” link.

   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.

   
   

9. 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.

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

11. 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.

     Selecting this option will default the Practice/Group NPI to print in box 33a even if the provider is set to bill as “Individual.”

12. Print CMS-1500 as NY Workers' Compensation Form (C-4, C-4.2, C-4.3, or OT/PT-4): This option should be left unchecked for NY Workers' Compensation payers to send the CMS-1500 form (required after July 1, 2022).

13. 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.

14. Professional Options

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

    2. Default Claim Note: Add a default claim note that will be automatically copied to claims, when billing the claims electronically to this payer.

    3. 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.

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

    5. 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.

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

    7. Send patient address in Box 32 for Place of Service 12: Check this box if you would like to replace the facility address with the patient’s home address when the professional claim's POS is 12 for Box 32 of the CMS-1500 claim form.

    8. 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.

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

    10. Print ICD code for first diagnosis pointer in Box 24E: Check this box to print the first diagnosis Code in Box 24E on the CMS-1500 claim form.

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

    12. 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.

11. 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 76 of the UB-4 claim form.

    4. Print Taxonomy Code in Box 76: Check this box if you would like to include the taxonomy code as the qualifier in Box 76 of the UB-4 claim form.

    5. Print Taxonomy Code in Box 81CC: Check this box if you would like to print the taxonomy coder in Box 81CC of the UB-4 claim form.

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

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. Use the Override Billing Provider checkbox to send claims under a different Billing Provider. This allows you to send a different Tax ID, Taxonomy Code, or NPI based on a specific payer and provider combination.

13. 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.

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

15. 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.   

16. Click  to copy a provider’s configuration to other payers.

    1. Use the Provider Configurations drop-down menu to select the source provider.

    2. Use the Select payer(s) to copy provider configuration(s) to drop-down menu to copy configuration to other payers.

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

Follow the steps below to view and edit the billing options for patients associated with this payer.

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. 

   1. Do not apply prompt payment discounts: Check this box if you do not want any prompt payment discount codes to apply to this payer.

6. Click Save. 

Follow the steps below to view and edit the billing options for ERAs associated with this payer.

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. Process PR-45 (patient responsibility amount in excess of fee schedule/maximum allowable) as an Adjustment when an ERA is posted, rather than as Unpaid?

   1. If set to Yes, the system will adjust the PR~45 (patient responsibility adjustment due to a contractual overage) when an ERA is posted, rather than setting it as Unpaid. 

7. Process PR-242 (services not provided by network/primary care providers) as an Adjustment when an ERA is posted, rather than as Unpaid?

   If set to Yes, the system will adjust the PR~242 (services not provided by network/primary care providers) when an ERA is posted, rather than setting it as Unpaid. 

8. Click Save.