Add payers

RXNT provides a master payer list, which pulls in a comprehensive payer list and payer profile database. This list is updated twice daily to provide you access to the latest payer information in near real-time.

Add a new payer from the master payer list

Click the Utilities icon in the top right corner.

Click Practice Setup then Insurance Companies.  

Click + New Payer in the top right corner.

Click Select From Master Payer List.

Enter a value in any of the following fields:

• Payer Name: The payer name. For example, Aetna.
• Payer ID: The Payer ID associated with the payer. Learn more about Payer IDs through the Relay Exchange clearinghouse here!
• CPID: The Claim Payer ID associated with the payer. Learn more about CPIDs in the Payer List Portal here!

Click on the Search icon. This will retrieve the latest information for the associated payer using the Payer Finder API. 

Select a payer from the returned search results, then click Create Payer.

The payer data will be populated on the Payer screen.

 The following fields cannot be edited:

• Standard Payer Name 
• Professional Claim
• Professional ERA 
• Institutional Claim 
• Institutional ERA
• Dental Claim 
• Dental ERA
• Eligibility 

Make sure the correct CPIDs for each payer match the Relay Exchange Claims and Remittance Payer List. Learn more about CPIDs here!

Choose the Claim Filing Indicator and Type of Health Insurance from the dropdown lists. For example, if the patient has Medicare coverage, select Medicare Part B for the Claim Filing Indicator and Medicare for the Type of Health Insurance. 

Provide any additional details for the payer to ensure accurate billing and claims processing. This includes whether the provider accepts assignment (e.g., Yes or No), the default fee schedule that should be applied for services (e.g., Medicare, Medicaid, or a commercial fee schedule), and the financial class of the payer (e.g., Commercial, Government, or Self-Pay). 

To enable payer eligibility, check the Enable Eligibility box and select the payer from the Eligible Payers dropdown menu. Additionally, choose whether to Include or Exclude the Patient SSN on Eligibility Checks.

Click Save to add the payer to your list of insurance companies. 

Add a new custom payer

Use this option when the insurance company you need is not already listed in the Master Payer List. Adding a custom payer allows you to manually enter the payer’s details so it can be used for billing, claims processing, or eligibility verification. This is commonly used when working with smaller regional insurance companies, third-party administrators (TPAs), or plans that are not included in the default payer list.

Click the Custom Payer checkbox. 

Enter the payer's name in the Payer Name field.

Enter the payer’s mailing Address. Providing the payer’s Phone and Fax numbers is optional, but it can be helpful for quick reference or when contacting the payer regarding claim status, eligibility questions, or billing inquiries.

Provide any additional details for the payer to ensure accurate billing and claims processing. This includes whether the provider accepts assignment (e.g., Yes or No), the default fee schedule that should be applied for services (e.g., Medicare, Medicaid, or a commercial fee schedule), and the financial class of the payer (e.g., Commercial, Government, or Self-Pay).

To enable payer eligibility, check the Enable Eligibility box and select the payer from the Eligible Payers dropdown menu.

Choose whether to Include or Exclude the Patient SSN on Eligibility Checks. By default, Include will be selected. If you do want the not patient's SSN included in eligibility checks, which the toggle to Exclude. 

Select the Claim Filing Method for each payer level, including Primary, Secondary, and Teritiary, to indicate how claims should be submitted for each insurance on the patient's account. 

If Print is selected as the Claim Filing Method, ensure that the payer’s mailing address is entered. This address will be used to route the printed claim, allowing it to be mailed to the correct payer for processing. Verify that the address is complete and accurate to help prevent delays in claim submission.

If Electronic is selected as the Claim Filing Method, ensure that both the Payer ID and CPID are entered. These identifiers are required to correctly route the electronic claim to the appropriate payer through the clearinghouse. Verify that both values are accurate and up to date to help prevent claim rejections or delays in processing.

Choose the Claim Filing Indicator and Type of Health Insurance from the dropdown lists. For example, if the patient has coverage through a commercial payer, such as Meritain, select Commercial Insurance for the Claim Filing Indicator and Other for the Type of Health Insurance.

Once all required information has been entered, click Save to apply the changes and add the payer to your payer list.

Update a payer

You may have received the following message after the claim scrubbing process is complete: “The payer ID for this professional claim is no longer valid. Please update the payer before resending the claim electronically. Click here to update.” If so, follow the instructions below to update the payer ID.

On the professional encounter screen, click the Click here to update hyperlink. This will navigate you to the Payer screen. From there, select Master Payer List. 

Enter the appropriate search criteria to locate the most up-to-date payer information. Click the Search icon to display matching results, then review the list and select the correct payer. Once the payer has been selected, click Create Payer to add it to your system.

On the Payer screen, review all entered information for accuracy, then click Save.

Claim specific rules

Claim specific rules are used when a payer requests certain information to be included in a particular section of the claim form. These rules need to be set up for each insurance company that you want to change what is displayed on the CMS 1500 claim form. When adding or editing a payer in the Insurance Companies section of Practice Setup, claim specific rules can be created at the bottom of the screen. Click here to learn more!

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