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TherapyNotes cannot send $0.14 EDI claims to payers not supported by Change Healthcare. You can tell a payer is not supported in two ways. First, when searching PAYERS at the top > “Payers Supported by Clearinghouse the search result reads “No payers matched your search” in red. Second, when adding a payer profile and typing in the “Ins. Provider Name” field, the Payer ID is not listed in the text before the payer and the Payer ID field does not autofill.

You have three options to submit claims to payers not supported by Change Healthcare.

Option 1: CMS-1500 – Free 
Add the payer profile. Set the “Billing Method” drop down box to “Paper (Print CMS-1500 forms or superbills)”. Leave the Payer ID field blank. Insert the paper claim mailing address of the payer. Click the green “Save New Payer” button. Your office must generate, print, and mail all CMS-1500 forms.

Option 2: Electronic CMS-1500 – $0.49 
Add the payer profile according to the instructions above. Set the “Billing Method” drop down box to “EDI (send claims electronically)”. Leave the Payer ID field blank. Insert the paper claim mailing address of the payer. Click the green “Save NewPayer” button. Treat these billing items like regular EDI claims. Click “Submit EDI Claims” to send the claim to the clearinghouse. The clearinghouse reviews the claim for errors, then prints and mails the claim to the paper claim address saved in the payer profile. These claims costs $0.49. Multiple dates of service per patient can be batched together in a single $0.49 Electronic CMS-1500 claim. 

Option 3: Submit Separately from TherapyNotes – Free 
Add the payer profile according to the instructions above. Set the “Billing Method” drop down box to “External (Submit claims separately from TherapyNotes)”. Leave the Payer ID field blank. Click the green “Save New Payer” button. Submit the claims in a system outside of TherapyNotes, such as through the payer’s online portal. After submitting the claim separately from TherapyNotes choose one of the following: 

  • BILLING > "Mark Externally Submitted Items" 
  • PATIENTS > Click name > "Patient Billing" tab > "Mark Externally Submitted Items" 
  • PAYERS > Click payer > "Payer Billing" tab > "Mark Externally Submitted Items" 
  • TO-DO > "Mark Externally Submitted Items" 

Locate the claim in question. If the line item's method is set to "External", then search under "Pending External". If the line item's method is set to paper or EDI, change the "Method" dropdown menu to "Pending Paper" or "Pending EDI". Then click the green button to mark the item as submitted. To learn more about submitting claims separately from TherapyNotes, see this article. This includes marking the claims as submitted as well as entering the insurance payment into TherapyNotes. 

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