Editing a payer may be necessary if the payer changes names, merges with another company, or when submission requirements are amended. Keeping up with these changes may reduce the number of corrections, rejections, and resubmissions necessary during claim processing.
Editing a Payer
Follow the steps below to make updates to a payer.
- Navigate to Practice Admin and click on Payers.
- The Payers listed will appear automatically on the drop-down list when choosing a patient’s insurance. Click on the payer that needs to be changed.
- To make a change that will affect all existing claims, change the Baseline by clicking the Edit icon.
- To make a change that will only affect future claims, or claims going back to a certain date, make a Scheduled Change Set for that effective date. Click the Edit icon next to the chosen Change Set date.
- Correct the fields that need to be edited and Save.
- Fields set by the Clearinghouse are not editable. This information is communicated to the clearinghouse by the payer and is automatically updated when changes are made.
Deactivating a Payer
Deactivating a payer means it will no longer appear on the payers or the clearinghouse list when selecting a patient’s insurance. You should only deactivate a payer when the payer will no longer be sent claims. Some payers have similar names. Deactivating the incorrect version can reduce confusion when selecting an insurance for the patient's treatment episode.
Deactivating is done under Practice Admin > Payers, in the same menu where edits are made to payer settings. Choose to make a Scheduled Change Set or a Baseline edit and switch the Is Active option to No.
To reactivate a deactivated payer, Create a Scheduled Change Set for the date this payer needs to be available for claim submission and change the Is Active option to Yes.
Deleting a payer
To delete a payer, navigate to Practice Admin for the desired Organization and Practice. From here click on Payers and click Delete next to the payer that needs to be removed. A payer can only be deleted if it is not associated with any patients.
Note: It is almost always better to edit or deactivate a payer rather than delete it. Deleting a payer can cause errors during submissions if the payer had been used prior to deletion.