Add payers

RXNT provides a centralized master payer list that includes a comprehensive database of payers along with detailed payer profiles. This ensures consistency and accuracy across your system when working with insurance information.

The master payer list is automatically updated twice daily, giving you access to the most current payer data in near real time. These updates help ensure that payer details, such as names, IDs, and configurations, remain up to date for accurate claims processing and eligibility verification.

Payers can be added and managed within the Billing, Scheduling, and EHR products, allowing your team to access and use the same payer information across all workflows. This integration helps reduce duplicate entries, improve efficiency, and maintain consistency throughout your practice.

Billing

Adding payers in the Billing product enables you to create and manage insurance profiles used for claims submission and reimbursement. You can choose from the master payer list or enter new payer details, ensuring accurate information is associated with patient cases and claims to support efficient and streamlined billing workflows. 

Add a new payer from the master payer list

Click the Utilities icon.

Click Practice Setup then Insurance Companies.  

Click New Payer.

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. 

Select the Claim Filing Method for each payer level, including Primary, Secondary, and Tertiary, 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.

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 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 Tertiary, 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.

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!

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 the 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.

Scheduling 

Adding payers in the Scheduling product lets you link insurance information to  patient cases and appointments. You can select an existing payer or add a new one, ensuring accurate insurance details are captured at the time of scheduling. This supports eligibility verification and helps streamline the billing process later in the workflow.

Add a new payer from the master payer list

Click the Utilities icon.

Click Practice Setup, then Insurance Companies. 

Click New Payer.

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!

Select the Claim Filing Indicator and Type of Health Insurance from the drop-down menus. For example, if the patient has commercial insurance, choose Commercial Insurance Co as the Claim Filing Indicator and Other as the Type of Health Insurance.

Choose whether to include or exclude the patient’s SSN in eligibility checks. By default, Include is selected. If you do not want the patient’s SSN included, switch the toggle to Exclude.

Select the Claim Filing Method for each payer level, including Primary, Secondary, and Tertiary, 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.

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.

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 patient's SSN included in eligibility checks, which the toggle to Exclude. 

Select the Claim Filing Indicator and Type of Health Insurance from the drop-down menus. For example, if the patient has commercial insurance, choose Commercial Insurance Co as the Claim Filing Indicator and Other as the Type of Health Insurance.

Choose whether to include or exclude the patient’s SSN in eligibility checks. By default, Include is selected. If you do not want the patient’s SSN included, switch the toggle to Exclude.

Select the Claim Filing Method for each payer level, including Primary, Secondary, and Tertiary, 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.

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

EHR only 

Adding payers to patient cases within the EHR should only be done if you are not using the Billing or Scheduling products. Clients should add payers through the Scheduling or Billing modules before linking them to patient cases in the EHR, as these modules manage payer information more efficiently and ensure consistency across the system.

Add insurance

Link payers to patient cases to ensure accurate insurance information is available for lab integrations.

To begin, navigate to the Patient Profile screen and click Insurance. 

Click Add Case.

Enter a case name and description that clearly identifies the purpose of the case. For example, for an insurance case you might use “Primary Insurance - Blue Cross” with a description like “Insurance coverage used for prescriptions and eligibility checks,” or for a self-pay case you could use “Self Pay - Patient Responsibility” with a description such as “Services not covered by insurance; patient is responsible for all charges.”

Select the Case Type from the dropdown menu, such as Self-Pay or Insurance, depending on the patient’s coverage.

If you are creating a case for Employment, Abuse, Other Accident, or an Auto Accident, select the appropriate checkbox under the Patient Condition Related To section.

If you are adding a referring physician to the case, select the Patient was referred by Physician checkbox and choose the physician from the dropdown menu.

To add a referring or primary care provider, click New Provider, enter the required information, and then select Add.

Enter the date the patient was referred in the Date Referred field.

To add payers, scroll to the Insurance Information section and select Add Insurance.

Select the subscriber from the Subscriber Relationship dropdown menu, which identifies the patient’s relationship to the insurance policyholder. Options include:

• Self – The patient is the primary policyholder
• Spouse – The patient is covered under their spouse’s plan
• Child – The patient is covered as a dependent child
• Other – Any other relationship to the policyholder not listed above
   

Choose the subscriber from the Subscriber dropdown menu. You can update existing subscriber details by selecting Edit Subscriber or add a new subscriber by clicking New Subscriber.

Choose the insurance company from the Payer dropdown menu. You can update existing payer details by selecting Edit Payer or add a new payer by clicking New Payer. 

If you are adding a new payer, enter the payer’s name in the Name field on the Add Payer screen.

Enter the NPI of the provider who is enrolled with the payer, ensuring it matches the provider’s credentials on file with the insurance company. This helps ensure accurate identification, supports eligibility verification, and reduces the risk of claim or prescription processing issues.

If applicable, enter the EIN and/or TIN in the respective fields. 

Enter the payer’s address in the appropriate fields. 

Enter the payer’s phone and fax numbers in the appropriate fields to ensure accurate contact information is available for communication and follow-up.

Select the appropriate Submission Mode from the dropdown menu.

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

The Electronic ID – Claims & ERA and Electronic ID – Claims Status fields are used to identify the payer within electronic transaction networks. 

Select the appropriate options below if you are a full suite client creating and submitting claims electronically. These settings control how claim data is formatted and transmitted to ensure compliance with payer requirements.

• Secondary Paper Filing - Indicates whether a secondary paper claim should be generated when a primary electronic claim has been submitted, often used when electronic coordination of benefits is not supported.
• Use Taxonomy code in 24J shaded and on EDI - Ensures the provider taxonomy code is included in the appropriate claim field (24J shaded area and electronic submission), helping payers correctly identify the provider’s specialty.
• Always display service facility NPI in HCFA - Forces the service facility’s National Provider Identifier (NPI) to appear on the CMS-1500 (HCFA) claim form, ensuring accurate location identification for services rendered.
• Suppress Rendering provider NPI in 24J and on EDI - Hides the rendering provider’s NPI in the specified claim fields when required by payer rules or billing configurations.
• Electronic Service Level - Defines the level of electronic claim service being used, helping determine how claims are processed and transmitted within the clearinghouse or payer network.

You can enter any relevant information in the Notes field. This area can be used to document additional details, special instructions, or context related to the record, helping provide clarity for future reference or internal communication.

After entering the required information, click Add to save and add the payer to the patient case. 

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