Add and Manage Payers

There are two types of payers in the RCM: Electronic and Paper. Electronic Payers are payers that accept electronic claim submissions sent from the RCM. Paper Payers require that a claim be printed and mailed directly to the payer before it will be accepted for adjudication. Let's review both payer types together!

User Permissions

Only users with admin-level profiles can add and manage payers in the RCM. For more information on user permissions, click here.

Getting Started

Before we learn how to add a payer to the RCM, let's go over a few items to keep in mind during the process.

Payer Names and IDs

Some payers may not be displayed with the exact ID or name in the system because the list is determined by our clearinghouse Waystar. When Waystar receives a claim, they will often update the payer ID internally to ensure it routes to the correct payer. To review a list of Waystar payers, click here.

Payers and Enrollments

When selecting a new payer to add to your configuration, you will see a box with a list of electronic communication types. A green checkmark indicates that the payer supports the communication type.

Some items may say "Yes (with Enrollment), which means that the communication type is supported, but enrollment is required before an electronic connection can be made. When enrollment is required, an enrollment request is created and sent to our enrollment specialist, who will then add it to your organization's Smartsheet.

For example, if the payer supports remits with enrollment, an enrollment must be completed before the remit can be successfully transmitted and posted to a claim. For more information on enrollments, click here.

Add a New Payer

Let's review how to create both an electronic payer and a paper payer in the RCM!

Navigate to the Practice Admin > Insurance Payers section of the RCM.

1. Next, click Import Electronic Payer.
2. Enter the payer ID or payer name in the Payer field and click their name.
  - If you are unable to locate the payer using the ID, please contact Support for additional assistance.
3. When applicable, add the Payer-Assigned ID.
4. Toggle on Allow Multi-year Claims to prevent claims from splitting when they span more than one year.
5. Finally, click Add Payer to complete the process.
1. Next, click Create Paper Insurance Payer.
2. Type in the payer's name (this is who the claim will be addressed to).
3. Enter the Paper Payer ID as 98999, and when applicable, enter the Payer Assigned ID. A claim form rule must be created in order for the ID to be included.
4. Select the Allow Multi-Year Claims checkbox to allow dates of service that span more than one year on the same claim.
5. When applicable, choose an option from the Parent Payer drop-down.
6. Add the following information:
  - Address: Enter the mailing address, including any P.O. box, suite number, unit number, etc.
  - City/State: Enter the city and state of the payer's physical mailing address.
  - Zip Code: We recommend using the full 9-digit zip code when available.
7. Disregard the additional drop-downs and fill in the Claim Filing Indicator field when appropriate.
8. Finally, click Add Paper Payer to complete the process.

Manage Payers

Let's review how to manage payers!

1. Navigate to the Practice Admin > Insurance Payers section of the RCM and click the payer's name to open their profile.
2. To update the payer profile for all claims billed, click Baseline.
3. To update the payer profile for claims as of a specific date, click Create Scheduled Change Set.
4. Add the effective date and click Save.
5. Next, click the edit icon.
6. Update the desired fields and click Save to complete the process.
1. Navigate to the Practice Admin > Insurance Payers section of the RCM and click on the payer's name to open their profile.
2. To convert the paper payer for all claims billed, click Convert under the Baseline column.
3. To convert the paper payer profile for claims as of a specific date, click Create Scheduled Change Set.
4. Add the effective date and click Save.
5. Next, click Convert.
6. Locate the payer in the Clearinghouse Payer drop-down and click Convert to complete the process.
1. Navigate to the Practice Admin > Insurance Payers section of the RCM and click on the payer's name to open their profile.
2. Next, click Create Scheduled Change Set.
3. Add the effective date and click Save.
4. Next, click the pencil icon to edit.
5. In the edit window, click on the Is Active toggle to turn it off.
6. Finally, scroll down and click Save to complete the process.
Payers who have not yet been billed can be removed from your configuration by clicking Delete next to their name. Payers with whom claims have been submitted can only be deactivated, but not deleted.