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Insurance Company Payers, Charge Types (article)

Summary:

All possible payer sources and charge types to the client are managed in this area.

The left side of the screen shows the list of payers that have already been entered. Select a payer on the left in order to view and edit the applicable information. Enter as much information as possible.

Field Descriptions:

Exclude from EDE (Electronic Billing) – check this if you do NOT want this payer to be billed in your EDE files

Include on Statements – includes this payer or charge type on all statements for the client

Exclude from Billing Service Calc. – not applicable unless you use a PIMSY billing service

In Network Group –user group that contains all the providers that are considered In Network

Type Indicator – Describes the type of Payer or Charge type for this item

Billing Code Group – select a billing code group if applicable.  This should contain a list of billing codes that this Payer recognizes and will pay

Assign to All Active Clients (Primary) (Secondary) – This button will assign all the active billing codes or all the billing codes in the Billing Code Group above to all the Active clients that have this insurance as the Primary Insurance or Secondary Insurance depending on which button you click.  

Make sure you read the pop up messages that appear when you click these buttons.  

Coding Requirements – This section allows you to control the different diagnosis coding requirements for each payer. PIMSY will only send the preferred diagnosis codes to the payer in electronic billing.

Instructions:

Go to the Administration tab and select Insurance Companies, Payers, and Charge Types

On the Default Amounts tab, enter the Billing Code and the Allowed Billing Rate/Unit, the Expected Amount/Unit with a Start Date and End Date. It will automatically enter the last two columns. These are the Default settings for these codes without the specific Title and Modifier requirements. The system will look here after it has already checked the first two tabs to get specific values for this payer or charge type.

Use Case:

The ABC Therapeutic Group accepts assignment with several client insurance companies and payer sources. All sources will need to be set up in PIMSY by their Administrator. The administrator goes to the insurance company setup area and adds each payer source (insurance companies, Medicaid, Medicare, state funds, federal grants, etc).

Now, each of these payer sources is available in the system to be attached to a client for billing, claims, and service documentation.

Related Articles:

If you cannot find what you need in this article, please contact Support (email) or call 877.334.8512 ext. 3.

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