How to Add and Update a Payer?
Our Master Payers List has been updated with the most comprehensive, up-to-date payer list available! We've implemented the Payer Finder API, which pulls in Change Healthcare's comprehensive payer list and the Payer Profile Database. This list is updated twice daily to provide you access to the latest payer information in near real-time. <
Click the utility icon in the top right corner.
Then on the left-hand side, click Practice Setup and Insurance Companies within the dropdown.
Click + New Payer in the top right corner of the Insurance Companies screen.
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.
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 OK.
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
- Professional ERA
- Institutional Claim
- Institutional ERA
- Dental ClaimERA
- Dental ERAClaim
- Eligibility
Enter the required information and click Save. This saves the payer in our system.
By selecting New Payer, you are able to allocate the payer or person/entity responsible for the payment of the claim.
Next, select the Custom Payer checkbox and complete the necessary fields.
You may have received the following message after the claim scrubbing process is complete: “The payer ID for this claim is no longer valid.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.
Click here on the message. Then click 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 OK.
Click Proceed to verify and update the payer information.
On the Payer screen, click Save.
How to Set a Claim-Specific Rule
Note: These rules need to get set up for each insurance company that you want to change what is displaying from the drop-down on the CMS 1500 form for each selected payer.
Under Practice Setup and Insurance Companies.
The image below is from inside a payer profile. Navigate down to the Claim Specific Rule and select the green +.
Click the drop-down. RXNT provides a list of claim-specific rules that will display on a preferred line item on the 1500 (HCFA) form as such:
| HCFA Box # | Claim-Specific Rule Descriptions/Identifiers |
| 1A & 9A | Swap 1A and 9A columns for Policy Number on the Claim form |
| 3 | Display box 3 DOB in Box 11 when the subscriber is self |
| 3 & 11A | A new claim-specific rule is added to display the date of birth from Box 3 in Box 11a when the subscriber is self. This claim-specific rule will only apply to print claims. |
| 2 &5 to 4&7 | When a subscriber is the self: Duplicate information from boxes 2 and 5 into 4 and 7, respectively |
| 10D | Display Condition Code on Box 10 D |
| 12 | Hide signature on Box 12 |
| 13 | Hide signature on Box 13 |
| 14 | Move the date of initial treatment to box 14 of the print claims |
| 14 | Suppress the qualifier in box 14 of print claims |
| 17A | Display Provider Commercial Number on Box 17A |
| 17A | Display Taxonomy Code on Box 17A |
| 19 | Display Last Seen Date on Box19 |
| 19 | Display CLIA on Box 19 |
| 19 | Send Demonstration Project Identifier in Box 19 |
| 24H | Send EPSDT reason code on EDI and Display in 24H shaded area |
| 24J | Use the Taxonomy code in Box 24J shaded in the claim form and EDI |
| 24J | Suppress Rendering provider NPI in Box 24J |
| 24J | Use Provider Commercial Number in Box 24J shaded. |
| 24J | Use State License Number in box 24J (shaded) on the claim form and the EDI |
| 25 | Use rendering provider SSN in Box 25 on the claim form and EDI |
| 28 | Display "Continuation" in box 28 of Medicaid paper claims |
| 29 | Suppress payment information in box 29 |
| 30 | Display balance due in Box 30 of CMS-1500 form |
| 32 & 33 | Suppress Info in Box 32 if same as Box 33 |
| 33B | Medicaid - Show Taxonomy code on Box 33B |
| 241 & 33B | Remove the G2 qualifier from box 241 and box 33B |
| 11 | Display box 3 DOB in Box 11 when the subscriber is self |
| Always display service facility location NPI in the claim form | |
| Send Family Planning Indicator on 2400 SV1 (Medicaid claims) |
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| Send EPSDT Information on the claim form and EDI | |
| Create a claim at the line item level | |
| Medicare of Massachusetts | |
| Custom Claim Notes and Comments | |
| Send Non-Covered Charge Amount on EDI | |
| Display delay reason code in loop 2300 | |
| Add provider suffix to professional claims. | |
| Send medical records for electronic claims | |
| Send referring and reference laboratory CLIA numbers on the electronic claim |
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Display CLIA on CMS 1500 Form, Box 19
Practice Setup and Insurance Companies.
In the drop-down, select display CLIA on Box 19 and save.
Next, go into Service Facility Location
Add the CLIA #
Lastly, go into Procedure Codes and make sure the procedure code is set as a CLIA Lab Procedure.
Once all those things are done in your encounter, make sure you are billing a payer that has the claim-specific rule you set up at the Service facility location, where you populated the correct information and you linked the correct procedure code, and that will update the populated information for you on box 19.
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