Import an Electronic Payer

  • Updated

There are two ways to create an Electronic Payer in Avea:

  1. You can import the electronic payer when building the prospective or admitted treatment episode.
  2. You can import an electronic payer when adding an insurance policy to the patient's treatment episode if the payer is not already available.
  3. You can add the electronic payer directly to the Payers tab in Practice Admin. 

When creating a Treatment Episode

If you cannot locate the patient's payer when creating the treatment episode, you can add a new electronic payer to the practice on the fly. 

  1. From the Add Insurance section of the modal, select the New Payer radio button.
  2. Click into the Payer tab and search for the payer or scroll through the Clearinghouse Payer list. Tip: Search by Payer ID to ensure claims are routed to the correct payer as payer names on the insurance cards may varry.
  3. Fill out the following details:
    1. Payer’s Name
    2. Payer-assigned Provider ID: This optional field is the unique identifier the payer has assigned to the provider.
    3. Allow Multi-year Claims: Check this box to allow claims to be created that contain treatments for more than one year (e.g., services provided in December and January) for this payer. Alternatively, if the payer requires treatments to be split out by year, leave this toggled off. This will create individual claims for those treatments by year. 
    4. Parent Payer (If applicable)
    5. Address
    6. Supports Institutional Claims: Options include No, Yes, or Yes (with Enrollment).
    7. Supports Professional Claims: Options include No, Yes, or Yes (with Enrollment).
  4. Once the payer is selected, you will be able to see what the payer supports electronically.  

    • Supports Professional Claims: Do they accept professional claims electronically? This will also let you know if enrollment is required for electronic submission.
    • Supports Institutional Claims: Do they accept institutional claims electronically? This will also let you know if enrollment is required for electronic submission. 
    • Supports Eligibility: Do they provide electronic eligibility? 
    • Supports Remits: Do they send out electronic remittance advice? This allows the system to auto-post the payments received to their matching claims. 
    • Supports Claim Status: Do they provide claim status updates to the clearinghouse? 
    • Supports Estimation 
    • Supports Claim Attachments: Do they support sending claim attachments electronically? 
  5. When the correct payer is located, you can make the following updates:
    • Update the Name if you'd like to change how this provider name appears to make it easier to select the correct insurance for the patient.
    • Complete the Payer-Assigned Provider ID. This optional field is the unique identifier the payer has assigned to the provider.
    • Allow Multi-year Claims: Toggle this on to allow claims to be created that contain treatments for more than one year (e.g., services provided in December and January) for this payer. Alternatively, if the payer requires treatments to be split out by year, leave this toggled off. This will create individual claims for those treatments by year.
  6. Click Next: Add Policy Info to continue. Click here for full instructions. 

From the existing Treatment Episode

If you cannot locate the patient's payer when creating the Insurance Set, you can add a new payer to the practice on the fly with the following instructions. 

  1. When you cannot locate the payer from the Select Payer dialog box, click the Add New Payer link.
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  2. Click into the Payer tab and search for the payer or scroll through the Clearinghouse Payer list.
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  • Important: We recommend searching by Payer ID rather than Payer Name. Payers may be listed on the insurance card under a different name than how they appear in Waystar. As long as the Payer ID selected is the same, the claims will be routed to the right place. Example: The patient’s insurance card lists the Payer Name as Blue Shield of Arizona and the Payer ID as SB530. The payer pictured below is the correct selection because the payer IDs match even if the names do not.
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  • Once the payer is selected, you will be able to see what the payer supports electronically.  

    • Supports Professional Claims: Do they accept professional claims electronically? This will also let you know if enrollment is required for electronic submission.
    • Supports Institutional Claims: Do they accept institutional claims electronically? This will also let you know if enrollment is required for electronic submission. 
    • Supports Eligibility: Do they provide electronic eligibility? 
    • Supports Remits: Do they send out electronic remittance advice? This allows the system to auto-post the payments received to their matching claims. 
    • Supports Claim Status: Do they provide claim status updates to the clearinghouse? 
    • Supports Estimation 
    • Supports Claim Attachments: Do they support sending claim attachments electronically? 
  • When the correct payer is located, you can make the following updates:
    mceclip5.png
    • Update the Name if you'd like to change how this provider name appears to make it easier to select the correct insurance for the patient.
    • Complete the Payer-Assigned Provider ID. This optional field is the unique identifier the payer has assigned to the provider.
    • Allow Multi-year Claims: Toggle this on to allow claims to be created that contain treatments for more than one year (e.g., services provided in December and January) for this payer. Alternatively, if the payer requires treatments to be split out by year, leave this toggled off. This will create individual claims for those treatments by year.
  • Click Add Payer. This will automatically add the payer as the patient's insurance and open so that you can add in the policyholder information.
  • Additionally, this payer is now available in the Practice’s Payer list and selectable when adding the insurance to the patient's treatment episode.

Practice Admin

Let's review how to add an Electronic Payer in the Practice Admin. Important: Only Admins can access this tab. For non-Admin users, please either contact the account admin or add the payer from the patient level.

  1. Navigate to Practice Admin > Payers. mceclip6.png
  2. Click Import Electronic Payer.mceclip7.png
  3. Click into the Payer tab and search for the payer or scroll through the Clearinghouse Payer list.
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  • Important: Payers can go by different names, so we recommend searching by Payer ID instead of name. If the payer ID is how the claims are routed from the clearinghouse. 
  • Once the payer is selected, you will be able to see what the payer supports electronically.  

    • Supports Professional Claims: Do they accept professional claims electronically? This will also let you know if enrollment is required for electronic submission.
    • Supports Institutional Claims: Do they accept institutional claims electronically? This will also let you know if enrollment is required for electronic submission. 
    • Supports Eligibility: Do they provide electronic eligibility? 
    • Supports Remits: Do they send out electronic remittance advice? This allows the system to auto-post the payments received to their matching claims. 
    • Supports Claim Status: Do they provide claim status updates to the clearinghouse? 
    • Supports Estimation 
    • Supports Claim Attachments: Do they support sending claim attachments electronically? 
  • You can make the following updates:
    mceclip9.png
    • Update the Name if you'd like to change how this provider name appears to make it easier to select the correct insurance for the patient. For example, United Health Integrated Services may be more commonly recognized internally as UMR.
    • Complete the Payer-Assigned Provider ID field only if the ID is different from what is in the clearinghouse's system. This ID is usually assigned to a provider during payer registration. 
    • Allow Multi-year Claims: Toggle this on to allow claims to be created that contain treatments for more than one year (e.g., services provided in December and January) for this payer. Alternatively, if the payer requires treatments to be split out by year, leave this toggled off. This will create individual claims for those treatments by year.
  • Click Add Payer. This payer is now available in the Practice’s Payer list and selectable when adding the insurance to the patient's treatment episode.

Import Electronic Payer (For Remits Only)

To import an electronic payer for remits only, click Import Electronic Payer. Here you will be able to search by either the payer name or the payer ID. Once the remit-only payer is displayed correctly in the dialog box, click Import.

Note that Remit Only payers do not accept claims or eligibility inquiries. Remit-only payer profiles will live under the Practice Admin Payers list and will not display as an available payer when creating a patient's insurance set. These payer profiles can be used for payment posting only.

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