PATIENT ENCOUNTER PAYERS TAB


Patient payers are payers set up by an organization that can be attached at a patient level. For some payers the rules, requirements and billing criteria are different for each patient covered by that payer. Individual policies and requirements govern the payment terms for each patient.  

NOTE: For Careficient Agency Administrators, click on the following to learn more about the privileges for View Payers.

ADD PAYER  (Top)

To add a Payer, click on "Add Payer".  

NOTE: For Careficient Agency Administrators, click on the following to learn more about the privileges for Add Payer.

To enter a payer, you can search by "Enter Payer Name"...

Status...

or Payer Category...

Click "Search"

When you find your payer, click on the "Add Payer" icon.

Enter the required information and click “Save”.

PROFILE TAB  (Top)

You payer will then populate to the Payers Tab.  You will notice that there are several red or green bubbles to the right of the payer.  If the bubble is red, you will need to address the issues by clicking on the bubble. Green means that everything is good.  If you click on the "Profile" bubble, it will take you to the Patient Encounter Payer Profile Tab. 

REQUIREMENTS TAB  (Top)

If you click on the "Reqs" bubble, it will take you to the Patient Encounter Payer Requirements Tab. 

AUTHORIZATIONS TAB  (Top)

If you click on the "Auths" bubble, it will take you to the Patient Encounter Payer Authorizations Tab.  

RED BUBBLE  (Top)

WHAT DOES THE RED BUBBLE UNDER AUTHORIZATIONS MEAN?

Red line = visits have not been attached to the Auth. It does not mean that it's missing an Auth.

Once services are verified, the system will automatically attach the visits to the auth. 

When an authorizations are missing the system will generate a message in 3 different places:

#1 Invoice Errors: 

#2 Work Basket under Referral/Admission > Patient-Payer Data Incomplete: 

#3 Patient Payer Encounter in the Authorization screen:

ELIGIBILITY TAB  (Top)

If you click on the "Eligibility" bubble, it will take you to the Patient Encounter Payer Eligibility Tab. 

INSURED TAB  (Top)

If you click on the "Insured" bubble, it will take you to the Patient Encounter Payer Insured Tab. 

NOE TAB  (Top)

If you click on the "NOE" bubble, it will take you to the Notice of Election Tab. 

 

DELETE PAYER  (Top)

You can delete a Patient Encounter payer if the payer is inactive AND does not have any/all of the following information as part of their payer record:

  • Authorizations
  • Encounter Payer Bill Rates
  • Co-Pay Information
  • Employer Information
  • Payer Notes
  • Service Transactions Attached To Payer
  • Uploaded Documents
  • Encounter Payer Pay Rates
  • Eligibility Information
  • Insured Information
  • Notice of Election Information
  • Accounts Receivable Invoice(s) With Services Attached

NOTE:  If you move a billed invoice from one payer to another, you will not be able to delete the payer as the invoice keeps track of the original payer.   You will only be able to inactivate this payer.  

NOTE: If you create a detail adjustment for all services attached to an existing invoice and use the “Wrong Payer” as your adjustment reason, this will create a new invoice number.  In this situation, you will be able to delete the payer if it meets all the other criteria

To delete a payer, click on the "Trash Can". 

NOTE: For Careficient Agency Administrators, click on the following to learn more about the privileges for Delete Payer.

 

To view a payer, click on the "Magnifying Glass". 

You also have the option once you get to the Payer to see the following other tabs:

NOTES TAB  (Top)

Patient Encounter Payer Notes Tab

BILL RATES TAB  (Top)

Patient Encounter Payer Bill Rates Tab

PAY RATES TAB  (Top)

Patient Encounter Payer Pay Rates Tab

On the Payer Headers you will find: