Adding Payers

Modified on Sun, 10 Sep, 2023 at 10:00 AM

The Manage Payers section is where you will add the information for the payers you are submitting to, along with the service codes and activities that you will be submitting. Please follow the instructions below to add new payers to the system.

First, please select Manage Payer on the left side of the screen.

Select Add Payer to see the payer info screen.

Once you are on the payer info page, you will need to identify:
1. Insurance Type - (Other is fine to use as the standard selection).
2. Carrier Payer ID - This must be entered if you are electronically billing for claims. The carrier payer ID can be found on Office Ally.
3. Address - preferably the claims mailing address for your payer.
4. Day Club by Provider - This option will group claims together based on the same service code, same rendering provider, same location, and same insurance where services are being rendered, and the same client.
  1. For example if you are conducting a morning session with John Doe using the code 97153 at home and in the afternoon you conduct the same service at the same location and use the same service code, Day Club by Provider will group the units together in accordance with payer guidelines.
5. EDI Payer - This will indicate that you are electronically sending claims to the payer.
6. Practitioner is Rendering Provider - This option allows you to bill under the practitioner’s NPI. Please check with your payer first before marking this option.
  1. For example Tricare allows you to bill under the paraprofessional’s NPI. This would be a use case scenario for this option.
7. Tricare - This option allows for the session time to be listed on the 1500 form and electronically sends the session time to Tricare.
8. Add Country Code in Box 19 - Can leave blank (used for international clinics)
9. Day Club by Provider w/ Same DOS on one claim - Similar function to “Day Club by Provider” option, however this option will also combine different services on the same day for the same client and rendering provider at the same location (for example 97153 and 97155).
10. Box 32 Should Be Blank if Address and NPI are the same as box 33 - make sure to enable this, as this is an Office Ally requirement. If the Service Location and the Billing Address are the same, then that address will only be sent once.
11. Send Ordering Provider NPI in EDI Claim - Enable only if the specific payer requires it

Under Payer Service Codes you will need to make sure:
1. The contracted rates are reflected for each payer.
2. All Modifiers are applied as needed by clicking the Edit icon.
3. Your rounding rules reflect correctly for each payer added.

Payer Activity - once you have added your contracted rates you will need to:
1. Attach your service codes to each activity.
2. Update your billed rates as needed.

Please use the link below to learn more about adding payer activities and setting billing rates for each activity.

Attaching Payer Service Codes to Payer Activities