Set Up Claim Settings: Payers

Edit Insurance Payers in PracticeQ to avoid errors and enter settings to streamline your billing.

Important notes about Insurance Payers:

• If you integrate with Office Ally or TriZetto, these clearinghouses will provide comprehensive payer lists to PracticeQ.
• Clients select from the Payers list when choosing their Insurance Payer on Intake forms.
• If you cannot find an Insurance Payer in your search, please contact hello@intakeq.com for assistance. We recommend that you do this before attempting to add a custom payer.

Insurance Payer Actions:

• To delete a payer, click the X Remove button to the right of the payer row.
• To add a payer, click the + Add Payer button.
• To edit a payer, click the Edit button to the right of the payer row.

  

Edit an Insurance Payer:

• The Name and Payer ID fields are grayed out and cannot be edited.
• Payer Type is typically filled in by the clearinghouse.
• The Street Address, City, State, and Zip Code fields can be completed if required.
• The Alias, if provided, will display instead of the payer name throughout the system, with the exceptions of claims and superbills.
• Enter a Default Facility if you need to force a specific service facility for this payer. This is not common.
• Add Out-of-Network Providers when services will be charged at the full rate and the practice is filing claims as a courtesy to the client.
• Click the checkbox for I'm an out-of-network provider with this payer (send payments to client) if the payer sends payments to the client instead of the provider. This will default the field Accept Assignment to No in claims for this payer.
• Click the checkbox for Force rendering provider NPI on claim if you want to force claims to include the rendering provider, even when it's the same as the billing provider. This will pull the rendering provider's NPI in both Box 24J and Box 33.
• Click the checkbox for Override Group NPI (Box 33) with Rendering Provider if you have an agreement with this payer that you will bill under the provider's personal NPI.
• Open the Add Provider ID menu if you need to override a Practitioner's default taxonomy code. When you open this menu, you will be prompted to select the Practitioner, the Qualifier, and the ID. This may be needed for Medicaid payers.
• Open the CPT Overrides menu if you need to enter custom rates, modifiers, or places of service for specific procedures. These overrides will apply to every new claim for the payer, but can still be edited on individual claims.
• Click Add Supervisor Relationship if there is a staff member who cannot bill to this payer. 
  • The Supervisor is a staff member who can bill the payer, and the Supervisee is the staff member who will bill under the Supervisor. 
  • When this is set up, Box 24J will populate with the Supervisor's NPI.
  • In Income reporting in PracticeQ, the income will still show under the Supervisee (the one who billed). 
• Click Add Allowed Amount if you have contracted rates with the payer.
  • You must enter an allowed amount for every code you plan to bill to the payer.
  • This allows PracticeQ to accurately calculate coinsurance amounts.