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Setting Up Payers in AccuBill

Updated

The second step (after setting user Permissions) in the billing setup process in AccuBill is configuring payers. Payers include Medicaid, Medicare, private insurances, self-paying clients, or any other entity from which your programs receive payments for services provided.

Permissions Needed 

To set up Payers in AccuBill, you need the following permission:

  • Configuration Mgmt. > Payers > CREATE or UPDATE or DELETE

 

Setting Up Payers 

Follow the guide below to set up Payers in AccuBill. 

 

Creating a New Payer 

To create a new Payer, follow the steps below:

  1. Click the green Create button.
  2. Within the modal, fill out the following sections:
    1. General Info
      1. Name - Required
        1. This is the name of the payer
      2. Payer Group - Optional
        1. Associates a payer group with the payer. This allows payers to be better organized and is also a filter when creating charges. Note: This list comes from Account Mgmt > List Creator > Payer Groups.
      3. Description - Optional
      4. Clearinghouse Payer - Indicates if the payer can have its claim files transmitted from AccuBill to a clearinghouse. Note: By default, the payer is not a clearinghouse payer. 
    2. 837 Claim Data
      1. 837 Payer- Indicates if the payer will be used to create 837 files in AccuBill. Note: By default, the payer is an 837 payer so most of the fields listed below are required.
      2. Payer Claim Name- Required when the payer is an 837 payer
        1. 837 Usage: NM1*40-03 & NM1*PR-03
      3. Address
        1. Street or PO Box - Required when the payer is an 837 payer
          1. 837 Usage: N3-01
        2. City - Required when the payer is an 837 payer
          1. 837 Usage: N4-01
        3. State - Required when the payer is an 837 payer
          1. 837 Usage: n4-02
        4. Zip Code (all 9 digits) - Required when the payer is an 837 payer
          1. 837 Usage: N4-03
      4. Payer/Receiver Info
        1. Receiver ID Qualifier - Required when the payer is an 837 payer
          1. 837 Usage: ISA-07
        2. Receiver ID - Required when the payer is an 837 payer
          1. 837 Usage: GS-03
        3. Receiver Code - Required when the payer is an 837 payer
          1. 837 Usage: GS-03
        4. Receiver Identification Code - Required when the payer is an 837 payer
          1. 837 Usage: NM1*PR-03
        5. Payer ID - Required when the payer is an 837 payer
          1. 837 Usage: NM1*PR-09
        6. Claim Filing Indicator Code - Required when the payer is an 837 payer
          1. 837 Usage: SBR-09
        7. Assign Default Reason Code - Situational
          1. 837 Usage: CLM-20
        8. When service date through billed date is greater than X days - Required when Assign Default Reason Code has a selection made
      5. Agency/Submitter/Sender Info
        1. Sender ID Qualifier - Required when the payer is an 837 payer
          1. 837 Usage: ISA-05
        2. Sender ID - Required when the payer is an 837 payer
          1. 837 Usage: ISA-06
        3. Sender Code - Required when the payer is an 837 payer
          1. 837 Usage: GS-02
        4. Sender Authorization Info/ID - Situational
          1. 837 Usage: ISA-02
        5. Sender Security Info/Password - Situational
          1. 837 Usage: ISA-04
        6. Submitter Agency Name - Required when the payer is an 837 payer
          1. 837 Usage: NM1*41-03
        7. Submitter Identification Code - Required when the payer is an 837 payer
          1. 837 Usage: NM1*41-09
        8. Submitter Contact Name - Required when the payer is an 837 payer
          1. 837 Usage: PER-02
        9. Submitter Phone Number - Required when the payer is an 837 payer
          1. 837 Usage: PER-04
    3. 270 Eligibility Data
      1. 270 Payer - Indicates if the payer will be used to create 270 files in AccuBill. Note: By default, the payer is NOT a 270 payer, so the fields listed below are NOT required. 
      2. Info Receiver/Agency Name - Required when a 270 payer
        1. 270 Usage: NM1*P-03
      3. Info Receiver/Program Identifiers
        1. Program Identifier ID #1
          1. Programs - Required when the payer is a 270 payer
            1. Select the program(s) to associate with the identifiers below
          2. Identification Code Qualifier - Required when the payer is a 270 payer
            1. 270 Usage: NM1*P-08
          3. Identification Code/Number - Required when the payer is a 270 payer
            1. 270 Usage: NM1*P-09
          4. Additional Identification Qualifier - Situational
            1. 270 Usage: REF-01
          5. Additional Identifier - Situational
            1. 270 Usage: REF-02
        2. + Add Item - click this if you need to add different identifiers for different programs
        3. Include Consumer Names - Situational
          1. 270 Usage: NM1*IL-03 & 04
        4. Include Consumer DOB and Gender - Situational
          1. 270 Usage: DMG-02 & 03
    4. Paper Claim Data
      1. CMS 1500 (HCFA) Options
        1. Single or Multiple Claims Per CMS 1500
          1. Select Single to report one charge per claim or Multi to report multiple charges per claim form
          2. Box 21 ICD Ind. - Required for these claims
            1. 1500 Usage: Box 21
        2. CMS 1450 (UB-04) Options
          1. Single or Multiple Claims Per CMS 1450 (UB-04)
            1. Select Single to report one charge per claim form or Multi to report multiple charges per claim form
          2. Box 2 - Report Address info from Billing Providers - Situational
            1. 1450 Usage: Box 2
          3. Box 38 - Report Payer Claim Name and Address - Situational
            1. 1450 Usage: Box 38
    5. Misc
      1. Notes
        1. Enter free text notes about the payer
      2. Active
        1. Indicates if the payer can be used within the Configuration Mgmt and Processing features
          1. Note: by default, the payer is active

 

Payers Table

Within the Payers table, you’ll see the following columns:

  • Name - Name for the payer record
  • Description - Description for the payer record
  • Payer Group - Payer group assigned to the payer record
  • Last Modified - The date and time the payer record last updated
  • ID - ID number assigned to the payer record by AccuBill
  • Actions
    • View Record - Click to view and edit the payer record
    • Change History - Lists all updates made to the payer record
    • Delete Record - Click to delete the payer record

 

Bulk Actions

By selecting at least one payer record checkbox, a footer will appear with the following:
  • Cancel - Deselects records and hides footer
  • Export - Exports selected records from AccuBill
  • All exports created by users will be maintained within the Exports modal (click Exports button in table header). Within the Exports modal, the following data is listed for each export:
  • Status - this will either report Pending, Complete, or Error
  • Exported - this is the date/time that the export was created
  • Expiration - this is the date/time when the export will be deleted by AccuBill
  • Note: This is 30 days from the date the export was created
  • User - this is the user who created the export
  • Download - this is a link to download the export file from AccuBill to the users computer
  • Compare - Compares multiple records side-by-side
  • Note: At least 2 records must be selected to activate this button
  • Duplicate - Creates a new record with the same data, just the name is different
  • Delete - Deletes the selected records
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