Normally, patient's have commercial health insurance paying for their claims. However, sometimes, it may be covered by a Workman's Comp case or Personal Injury/Car Accident case. These "payors" are typically insurance companies or could even be lawyer offices.
These are entered very similarly to a regular medical insurance:
1. From Admin -> Billing -> Payor Entry, select "Add New Payor" button
2. Fill in the appropriate fields:
Payor Name: Name of the payor (full name) which would be the Lawyer's office name, or Insurance name
Payor Code: Short name for the payor, this is only for the practice, could be an acronym or any abbreviated version of the payor name
Start Date: First date it is effective for your practice
Address, Phone, Fax and email are all helpful if you have it. Especially, if you have to mail in the claims or fax the claims.
Payor Type: Use Other, as this list was derived by the checkboxes on the original HCFA1500 claims form
Format: This SHOULD be "EDI 837P 5010" for any payor that will accept electronic claims *This is preferable for the fastest processing
Payor ID: When the format is electronic, this is REQUIRED as the electronic payor id. The Clearinghouse should be the determining factor on this ID
**Trizetto payor ID list can be found at this URL: https://payers.gatewayedi.com/payerlist/Default.aspx
3. Select the "Save" button
4. From the Patient Chart -> Patient Info -> Insurance screen, Add this payor as an Insurance policy for the patient:
After selecting the "Add" button, search for the new payor you entered in steps 1-3, and be sure to select the Insurance Level = Workman's Comp /
Liability
5. Typically, you will have a Case number that you can use for the Policy Number. Be sure to put the Effective From date as the first date the payor will accept for claims for this case. You can also add any other information in the Notes field if it will be helpful for collecting or submitting claims. Sometimes, there are specific rules that the companies have.
IMPORTANT NOTE: The Effective Dates are important, especially if this patient also have normal Primary medical insurance and is being seen in your office for other medical problems outside of the Workman's Comp or Liability claim. The system will want to assign this payor OVER the primary if the dates cover the date of service. So, if the patient comes back for normal medical care, you will want to END date this Workman's Comp / Liability insurance OR make sure you set the primary payor on the claim>
To set the Primary payor on the claim, go to Encounters -> Charges -> Claim Info, select the Payor and then make sure you set the Claim status to something other than Pending, typically Ready to Bill or No Bill (which only means this is not being transmitted to a normal insurance payor)
When the status is left in Pending, and the claim is selected here in Charges -> Claim Info or in the Billing Edit Claims screen, the system sees it is still pending scrubbing and it will assign the payor based on Workman's Comp / Liability to take precedence over the Primary and it will reprice according to that payor. The same thing will happen for setting a claim to any other payor level, like Alternate Primary, Supplemental, secondary, etc. Below shows a claim getting set to Self Pay as an Alternate Primary. The user has also set the status to No Bill to make this save appropriately.
