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| Field | Description |
|---|---|
| Payer Name | Enter the name of the payer.
When entering data into this field, the following three rules must be met:
When you modify the payer name, a message appears indicating the number of person or patient records associated with the payer. The message provides the following options:
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| NEIC/Payer Number | Enter the NEIC Payer Number. This number may also be set up for a specific clearinghouse and/or a specific payer. |
| Plan Number | Enter the plan number for the payer. |
| Payer Alias Name+ | Enter an alternative payer name to use when a name that differs from the name that appears in the payer's Payer master file is required. |
| Group Name/ Group Number | Enter the name and number for the group plan. The Group Number will display in box 11 of the HCFA 1500, field 61 of the UB, and field 21 of the ADA.
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| Plan Type | Select the plan type from the drop-down list. |
| External ID | Enter the external ID, which is a key for other applications to use when mapping fields. When another application needs to pull data from NextGen® Enterprise PM, the external ID identifies the NextGen® Enterprise PM file where this information exists. The other application can then access the file, pull information that it needs, and put it into a corresponding field. The External ID field is set up as an alphanumeric field. |
| Payer Expiration Date | Select the date from the calendar.
When you modify the payer expiration date, a message appears indicating the number of person or patient records associated with the payer. The message provides the following options:
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| Main Address/ Refund Address | Select the kind of address you want to enter. You can enter one address for each kind. 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 enter the ZIP code, and the city, state, county, and country automatically display. You can use the refund address in on the Patient's Insurance Maintenance window and in Payment Entry.
When you modify the address, a message appears indicating the number of person or patient records associated with the payer. The message provides the following options:
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| Contact: Last/ First/ Middle Name | Enter the contact name for the payer. |
| Contact Phone/Ext | Enter the phone number for the contact. The default area code comes from the General Practice Preferences. |
| Contact Fax | Enter the fax number for the contact. |
| E-Mail Address | Enter the e-mail address of the payer. |
| Source of Signature | To file a claim with insurance on behalf of the patient, you must have the patient signature. In this field, you can select from the following signature options:
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| Medicaid Sub Type | Only displays if Medicaid is selected as the Claim Type on Process on the System tab. This field is not currently used. |
| ERA Payer Numbers | Enter the Electronic Remittance Advice (ERA) Payer Numbers for this payer. Check with your payer or clearinghouse for the appropriate ERA payer number.
As an ERA number is entered or deleted, the application counts the number of ERA payer numbers. Use the scroll bar to review the current ERA numbers. When an ERA file is processed, the payer’s ERA payer number from this field is compared to the ERA payer numbers in the ERA file. These numbers must match before payments from this payer are posted. When multiple ERA payer numbers are assigned to a payer, the ERA Import process successfully identifies the payer when any one of the ERA payer numbers that was entered for the payer is found in the ERA file. In the 835 IG, the ERA payer number can be located in the GS02 segment. |
| RTA Payer Number | Not currently in use. |
| National Plan ID | Enter the identifier for the payer.
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| Payer Website | Enter the URL for the Web site of the payer, if applicable. |
| Refer Auth Req (Referral Authorization Request) | Enter one of the following:
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| Referral Form | Enter the referral form accepted by the payer. |
| Real Time Edits Payer ID | Enter the payer ID for Real Time Edits at the Payer/System level. The Payer ID identifies the client and payer and represents a set of Real-Time edits. The ID is 13 characters long. The first 6 characters are interpreted as the client ID and the last 7 characters are interpreted as the payer ID. This payer ID overrides the enterprise-level and practice-level IDs. |
| MSP Payer ID | Enter the CMS assigned nine-digit payer ID number. |
| Pricing Regions Library | Select the appropriate SIM Pricing Regions library that defines the pricing for this payer. |
| Payer is Tax Exempt | Select this check box to prevent sales taxes from being applied to any encounter billing this payer. The encounter becomes exempt from having sales taxes be applied. |
| Include tax charges on claims | Select this check box if you want tax charges to go to the payer each time the payer is billed. If the check box is not selected, the tax charges go to the patient bucket. The default setting for a new payer is selected, but you can set exceptions, like tax exemptions, as necessary. |
| Payer is Optical Management VSP Payer | Select this check box if the payer is an Optical Management VSP Payer to send orders to VSP. |
| Payer is Medicare Replacement Payer | Select this check box if a patient is over 65 years of age and has Medicare Replacement plan. If this check box is not selected, while attaching an insurance in NextGen® Enterprise PM for a patient who is over 65 years of age and Medicare or a Medicare Replacement plan is not selected, then the application alerts the user stating 'Patient is over 65 and Medicare was not selected'. |