Payers

The following functionality is exclusive to Self-Service Admin and Super Admin User Role only. For more information about user types and roles, visit the User Role Overview article.

In WebPT Billing, Payers are used to assign the Outbound and Inbound Payer IDs to a claim which dictates where it goes. Payers also have their own set of scrubbing rules and formatting logic. Additionally, there are some payers that require claims to contain one code over another, which requires code replacements. WebPT Billing uses the Payer to assign specific items like code replacements.

Override Default Settings

You can add company-specific overrides to change a payer’s default settings. Common uses include updating the default billing method (i.e. creating a paper claim instead of billing electronically), adding Payer IDs, and changing how secondary claims are handled.  

1. Go to Billing and select Payers.
2. Use the fields to search for a specific payer. Alternatively, leave the fields blank and click Search to view all.
3. The search results display below, double-click on the payer to open.Note: You can view the Cross-Company Settings for the payer, but you cannot make changes. If you’d like to change how the system handles your claims for this payer, please use the Company Specific Overrides described below.
4. Make updates to default payer settings on the Company Specific Overrides card.

Company-Specific Override Fields

1. Payer IDs (Inbound/Outbound)
   1. Inbound IDs: This is the ERA Payer ID. This ID allows the system to correlate an 835 to the appropriate payer in the system. While you typically want Inbound and Outbound IDs to match, some payers may send back more than one Inbound ID. If left blank, this field defaults to the Inbound ID in the Cross-Company Settings. You can locate these IDs in the Payer list of the clearinghouse.
   2. Outbound ID: This is the EDI Payer ID. This ID allows the clearinghouse to route the EDI/Claim file to the appropriate payer. If blank, this field defaults to the Outbound ID in the Cross-Company Settings. You can locate these in the Payer list of the clearinghouse.
      
      Note: If the company gets a new ID (i.e. Inbound ID), but the Cross-Company IDs still apply, users must copy and/or re-enter the IDs they still want from the cross-company card and add it (along with the new ID) into the Company Specific Overrides card.
2. Payer Group: The payer group allows you to determine the method of claim transmittal (i.e. paper, clearinghouse, etc.). Note: If you change the payer group, you must complete the Inbound and Outbound ID fields, or your changes will be made to all Inbound/Outbound IDs listed in the Cross-Company Settings card.
3. # of days to 999: This field has been added for a future product enhancement and does not have any current functionality. 
4. # of days to 277: This field has been added for a future product enhancement and does not have any current functionality.
5. Medicare Crossover: This field should only be used with Medicare secondary payers. If this box is checked and the primary insurance is Medicare, when the Medicare 835 is released and the file says the claim has been forwarded to the next payer, the system won’t generate a secondary claim. If this box is not checked, the system will always create a secondary claim regardless of what the 835 file says. 
6. Accepts Primary Paper Claims: This allows the user to demand a paper claim. If the box in the Cross-Company Settings isn’t checked and this drop-down is set to Default or No, the user will receive an error when trying to create a paper claim.
7. Accepts Secondary Paper Claims: This allows the user to demand a paper claim. If the box in the Cross-Company Settings isn’t checked and this drop-down is set to Default or No, the user will receive an error when trying to create a paper claim.
8. Accepts Secondary Claims Electronically: This allows the user to send the secondary claim electronically. If the box in the Cross-Company Settings isn’t checked and this drop-down is set to Default or No, the user will receive an error when trying to send the secondary electronically.
9. Include on 277 Report: This field is not applicable to Self-Service Members.
10. Treatment Notes Required: This field is not applicable to Self-Service Members.
11. Tax Identification Number: Indicate the TIN you'd like to use on claims for this payer. This will populate Box 25. 
12. Taxonomy Code: This field has been added for a future product enhancement and does not have any current functionality.
13. Type of Bill: This field has been added for a future product enhancement and does not have any current functionality.
14. Is Active: Your company overrides will apply whether or not this box is checked. 

Payer Insurances

All insurances related to this payer will appear in the Insurance Codes section.
Note: These insurances will be impacted by the Company Specific Overrides added.

Removing an Insurance

If you’d like to disassociate an insurance from this payer, you’ll need to complete the following steps.

1. Check the box next to the insurance code and select Remove Selected.
2. Navigate to the Admin menu and select Insurances.
3. Search for the Insurance you just disassociated and double-click to open the record.
4. Use the Payer Description field to associate the insurance with the correct payer.
5. Save.