This article explains how you configure the payor details.  


After adding a payor, it needs to be set up effectively. This tab allows us to configure payors and manage necessary details.


Configuration:

  1. Filters - Use the filters such as search insurance, active & is electric status, CMS tabs to locate the insurance(s).
  2. Active - Once you have added insurance, toggle on the Active Switch. Toggle it off to temporarily deactivate the payor without removing it.
  3. Is Electronic - Toggle this switch to enable electronic submission to the clearinghouse.
  4. CMS1500 31/32a/32b/33a/33b - Enter these data in order to populate them on the HCFA form.
  5. Save Payor Setup - Once you have made the changes, select the insurance(s) by clicking on the checkbox and click on Save Payor Setup 
  6. Further actions:
    1. Edit Payor - Click the pen icon to make further edits and adjust specific insurance information. Refer to the section below for detailed steps and images.


Edit Payor:


This section consists of three menus for configuring the selected insurance:


A. Box 33/ Box 33: In these tabs, you can add additional information for extra locations or specific needs.

Please note these boxes are not mandatory. If you need to send claims with different information in Box 33 & 32 than what is set in Facility settings, you will need to fill out these boxes.

    i. Box 33:

  1.  Facility/Individual: Choose whether claims should be sent with facility or individual information. Selecting an individual will include the provider's name on HCFA forms.
  2. Further Details: Add the facility address, city, state zip, NPI, Taxonomy and EIN if needed. 

Once you have made all the changes, click on Save Box 33.


    ii. Box 32:

  1.  Add Details: Add the facility's name, address, city, state zip, NPI, Taxonomy, and EIN if you have different regions. 

Once you have made all the changes, click on Save Box 32. 


Insurance Access:

  1. Active: Enabling this toggle makes the payor active.
  2. Is Electronic: Toggle this switch to enable electronic submission to the clearinghouse.
  3. Concurrent billing not allowed.
  4. Insurance Type: Choose the insurance type from the drop-down menu. 
  5. Don't Club: Toggle this switch if the claims shouldn't be clubbed. 
  6. Clubb with different POS: Enable this access to group the appointments with the same provider but different POS during claim generation. 
  7. Unclub with different providers: Toggle this switch if the appointments shouldn't be clubbed with different providers during claim generation.
  8. Fill Box 17: Enabling the toggle will update Box 17 in the HCFA form.
  9. Fill Time Range Box: Enabling this toggle will make it the required code.
  10. Rend. Provider On Service Line: Enabling this toggle will populate the provider's name on the service line in the HCFA Form. 
  11. PWK Segment.
  12. Tx Type/ Box 24J/ ID Qualifier: Add the Box 24J and the relevant ID Qualifier if needed. 

Once you have made all the changes, click on Save. 


Scrubbing Rules:

This section provides scrubbing rules that can be enabled to prevent issues in subsequent process steps.

  1. Run Rule: If you toggle this switch, the system will review the claims and provider scrubbing error in the Manage Claims tab.
  2. Prevent Rule: If you toggle this switch, the system will prevent the claims from moving to the next step until the errors are fixed. 
    Please note that you will not be able to toggle on the prevent rule until the run rule is toggle on.

Once you have made all the changes, click on Save.