The Payers Setting tab allows users to create a custom insurance database with unique shortcuts or modify existing insurance shortcuts.
Required Permissions
To access this page, users must be a Super Admin or have the Manage Utilization Review feature added to their profile.
There are a few reasons why you would need to add insurance to this page:
- Custom Naming Convention: You want to use a custom Payer Shortcode or Payer Synonym for the insurance. This can help staff more easily locate and select the correct insurance to add to the patient’s chart.
- Add New Payer: You want to use a payer that is not present in the default Kipu Insurance database. This allows you to add the payer to the patient chart and can be used when completing a Verification of Benefits (VOB) for the patient.
- Billing Integration: You are integrated with CMD for billing. The CMD billing integrations require using a custom payer list with external IDs that map to the payer in the billing system. Click here to learn more.
Note: For Avea Integration users, your payer list lives directly in Avea. Click here for instructions on managing Avea Payers.
Adding Payers
- Click on your initials and select Settings.
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Open the Payers tab.
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Click Add Item. You can use the Location drop-down to view payer rules tied to a specific location.
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Fill out the payer information in the Add/Edit Payer box that appears.
- Payer Search: Locate the desired payer by typing their name or payer ID into the Payer Search field and selecting the appropriate option from the drop-down.
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Payer Synonym: Enter the name of the payer in the Payer Synonym field. This field is required.
- Note: You may need to re-enter the payer synonym you wish to appear in this field after you select the VOB payer. Additionally, if you edit the Payer Synonym field, the system will look for records using that payer and update the name to match on patient facesheets.
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Payer Shortcode: Enter a payor shortcode that will help your facility identify the payer. For example, if the shortcodes are determined by numbers, enter the next sequential number. Otherwise, create whatever shortcode you would like.
- Note: If you edit the Payer Shortcode field, the system will look for records using that payer and update the name to match on patient facesheets.
- Internal Payer Name: You can give the payer a name that is only viewed by users in your organization.
- Internal Payer ID: Use this field to give a payer an internal payer ID that is only relevant to your organization.
- External ID: This field is for use with the CMD or AveaOffice billing integration. Click here to learn more. The External payer ID should be added from the CMD payer sequence number.
- Submission Type: Choose Electronic or Paper. This field is currently for data standardization purposes and is informational only.
- Plan Type: The selection made here will automatically populate when payer is chosen from the insurance look-up list.
- Payer Type: The selection made here will automatically populate when the payer is chosen from the insurance look-up list.
- Phone: The number added here will automatically populate when the payer is chosen from the insurance look-up list.
- Address 1 and Address 2: Add the first (and second if necessary) lines of the payer's address. Currently, the address fields are only available for instances that have active lab interface.
- City, State, Zip: Add the city, state, and zip code of the payer's address. Currently, the address fields are only available for instances that have active lab interface.
- Locations: If you have multiple facilities, select the facilities where this payer should be available. If you choose All Locations, any current locations will be selected, as will any locations added in the future.
- Click Submit to save your data.
Add Unknown Insurance to an Insurance List
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To automatically include new insurances in the payers list ensure the Allow free-typed insurances and add them to custom payer list Instance setting is enabled.
- Each time a new insurance is added to the patient facesheet, the user will receive a popup asking them if they want to proceed with creating the new payer.
- If the user clicks OK, the insurance is added to the payers list.
- The Payer Name is generated from whatever the user entered in the Insurance Company field on the facesheet and is automatically assigned a Kipu Insurance ID. You can update the shortcode and payer synonym as needed.
- Click Submit to save your changes.
Editing Payers
In addition to creating payers, you can also edit existing ones.
- To edit an existing payer, click on the edit pencil.
- Then make the desired alterations in the window and click Submit.
- If the insurance has already been added to a patient, you will see a warning at the bottom about the change affecting data, and the number of patients whose records will be updated.
- If desired, you can download the list as an Excel spreadsheet by clicking the Download button.
- If desired, you can download the list as an Excel spreadsheet by clicking the Download button.
- Then click Confirm.
- The window will close and your changes will be preserved.
Exporting Payers
If you need to export your payer list for any reason, click the Export Data text at the top of the page then select Export Payers.
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