Add or update a payer
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!
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.
Click Create Payer.
The payer data will be populated on the Payer screen.
The following fields cannot be edited:
- Standard Payer Name (Formerly known as Trading Partner Name)
- Professional Claim (Formerly known as Payer Electronic ID (HCFA Professional))
- Professional ERA (Formerly known as RealtimeTranEID (HCFA Professional)
- Institutional Claim (Formerly known as Claim Electronic ID (UBO4 Institutional))
- Institutional ERA (Formerly known as ERA Electronic ID (UBO4 Institutional))
- Dental Claim (Formerly known as Electronic Claim ID (Dental))
- Dental ERA (Formerly known as Electronic ERA ID (Dental))
- Eligibility (Formerly known as Eligibility EID)
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 list.
Also, provide any additonal payer details, including Accept Assignment, Default Fee Schedule, and Financial Class.
To enable payer eligibility, check the Enable Eligibility box and select the payer from the Eligible Payers dropdown menu. Additonally, 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
Click the Custom Payer checkbox.
The Claim Filing Methods will default to Print, but it can be changed to Electronic if needed. If Print is selected, ensure that the payer's address is entered.
If Electronic is selected as the Claim Filing Method, ensure that both the Payer ID and CPID are entered.
Complete the required fields, including Payer Name, Claim Filing Indicator, and Type of Health Insurance.
Also, provide any additonal payer details, including Accept Assignment, Default Fee Schedule, and Financial Class.
To enable payer eligibility, check the Enable Eligibility box and select the payer from the Eligible Payers dropdown menu. Additonally, choose whether to Include or Exclude the patient SSN on eligibility checks.
Click Save.
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 search criteria to find the most up-to-date payer information. Click on the Search icon and select the correct payer from the list.
Click Create Payer.
On the Payer screen, 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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