Payers Overview and Contracted Rates

In this article, we review where to see your payers list, how to add new payers, and edit, delete, and inactivate payers. We'll also cover how to add contracted payer rates. 

Where do I see my payer list?

To see what payers have been added to a practice’s profile or to add a new payer, go to Practice Admin and then click on Payers.

Import Electronic Payer

To add a new electronic payer, click Import Electronic Payer.  Click here for full instructions. 

Create Paper Payer

To create a paper payer, you may want to have the patient’s insurance card on hand to ensure you have the correct mailing address for the plan. Click here for instructions. 

Deactivating, Editing, and Deleting Payers

For instructions on managing payers, click here. 

Entering Payer Rates (Contracted/Expected Rates)

If services have been contracted with a payer, you can enter those contracted rates into the Payer Rates tab.

1. To add in a rate, you will need to go to the Payers section in Practice Admin. 
2. From there, click on the Name of the payer with the contracted rate (if the payer is not listed, follow the steps listed above to add a new payer).
3. Open the Payer Rates tab and click Create Payer Rate.
4.  Complete the following fields: 
   

   Service: Choose the service that is contracted. Service Billing Profile: Choose the corresponding Service Billing Profile. Amount: Enter the contracted rate for the service. Contracted Status: Choose Contracted or Not Contracted. Effective Date: Add the effective date of the contract. Review Date: Add the review date of the contract.

5. Once the information has been entered, click Create.
6. Once a payer rate is entered, it will be reflected in the balance of a claim as well as reporting.

Scheduled Change Sets for Renegotiated Rates

When the contracted rates are renegotiated in the future, you will need to create a Scheduled Change Set for the rate with the effective date of the new contract. 

To create a scheduled change set:

1. From the Payer Rates tab (Practice Admin > Payers > select Payer > Payer Rates), click on the Service. 
2. Click Create Scheduled Change Set.
   
3. Set the Effective Date for the change. 
4. Click the Edit icon on the new Effective Date. 
5. Update the details and click Save. 

Click here for more information on Scheduled Change Sets.