Box 38 will display the Responsible Payer's Name and Address on claims. The Responsible Payer can be the Primary, Secondary, or Tertiary Payer.
On Paper Claims
Both the Payer Name and Address for Paper Payers will always appear in Box 38. If a claim is forced to paper through a correction or Service Grouping Rule, the Payer Address will need to be included in the Payer Profile within the Practice Admin as described below.
On Electronic Claims
Electronic claims will always display the Payer name in Box 38 but not the address. To include the Payer Address in the EDI of an electronic claim, the Payer Address will need to be added to the Payer Profile in Practice Admin and a Claim Form Rule will need to be created to force the address to appear.
The Payer Name and Address is located in the Payer Profile within the Practice Admin as well as the Insurance Set of the Patient Profile.
In the Practice Admin
Let's review how to update the Payer Name and Address within the Practice Admin.
- Navigate to the Practice Admin > Payers > Payer List.
- Select the desired Payer Name to open the profile.
- Within the profile, select Create Scheduled Change Set to create the effective date of the change.
- Once the effective date has been set, select the Pencil icon next to the date to open the Edit screen.
- After the desired fields have been updated, select Save to update the Payer Name and/or Address.
In the Patient Profile
Let's review how to update the Payer Name and Address within the Patient Profile.
- Navigate to the Patient Profile > Treatment Episodes.
- In the desired Treatment Episode, select the Intake quick link in the drop down.
- From Intake, select the Insurance subtab then select the Insurance Set profile you wish to update.
- In the Insurance Set profile, select Edit.
- Toggle-off Use Practice Payer Address to update the Payer Address before selecting Save.