Add or Modify Provider Practice Payer
The following table describes the fields on the Add /Modify Provider Practice Payer window:
| Field | Description |
|---|---|
| Payer Name | Select the payer for whom you are setting up this group information. |
| Name/ Organization | Enter the name or organization for the provider. |
| Suspended Eff Dt | Enter the date after which the payer can no longer be billed for a claim. |
| Provider Number | Enter the provider number for the payer. |
| Street/ City/ State/ Zip/ Country/ County | The first space is for street number and name. The second space is for other address details such as suite number. If the ZIP code table is set up, you can type in the ZIP code, and the city, state, county, and country automatically display. |
| Loc ID | This field displays when the payer state is New York. Enter a two-digit numeric code to identify the location. Due to New York Medicaid requirements, this field is required when you attach a payer with a claim type of Medicaid and the payer state is New York (NY). The number in this field is then used to populate the corresponding field on the electronic file for NY Medicaid Direct and Halley for NY Medicaid claims for each provider. |
| Effective Date/ Expiration Date | Enter the effective and expiration dates for the rendering provider’s payer provider numbers. |
| Group Name | If the provider is associated with a group, select the group here. |
| CLIA Number | This field displays when you are setting up a payer that is not the default. Enter the applicable CLIA number (this only applies to a non-default payer). For more CLIA information, see the Claims User Guide for NextGen® Enterprise PM. |
| SIM Exception | If the payer has exceptions to how charges are normally paid, select the appropriate SIM Exception. |
| Contract Exception | If the payer has exceptions to how charges are normally paid, select the appropriate Contract Exception. |
| CPT4 Provider Nbrs | Select to set up CPT4 codes at the provider level and to attach a taxonomy code to a CPT4 range. The Valid Provider Numbers for Payer window displays. |
| Taxonomy Code | Select the taxonomy code associated with the claims for which the payer is billed. This taxonomy code overrides the one selected on the System tab. |
| Claim Value 1, Claim Value 2 | These fields are payer-specific and only display on the Provider Practice Payer window when you are setting up a payer that is not the default. If the provider number must be in formats different from the one in the Provider Number field for different kinds of claims, enter value to use for each alternate provider number. You can then select the value to use in the Payer master file. Open a Payer master file, select the System tab, then, in the Data Element column, select whether to use Opt Clm Val 1 or Opt Clm Val 2 on the HCFA, UB92, and Claims tabs . |
| Submitter Group | Select the Submitter Group that you want to associate with the payer displayed in the Payer Name field. Submitter Groups are created in the Submitter Profiles libraries. This field displays when you are setting up a payer that is not the default. |
| Provider Site ID | This field only displays when you are setting up the default payer. Enter an alphanumeric Provider ID that can be used as a secondary reference qualifier for electronic claims. By default, When each new provider is created, a default group information record is included. |
| Bill SSN with SY secondary reference | When this option is selected, the 2010AA Billing Provider Secondary Reference Qualifier REF01 is set to SY (Social Security Number). Data for this option is pulled from the Tax ID Number/SSN field on the Practice tab in the Provider master file into the REF02 segment. If the SSN for a provider is not in the system, the Tax ID number is pulled into the REF02 segment. If the option is not selected, the 2010AA Billing Provider Secondary Reference Qualifier REF01 is set to EI (Tax ID Number) and the Tax ID number is pulled into the REF02 segment. |
| RTA Enabled | Not currently in use. |