Organization Payers Menu

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Resources
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ROLE PRIVILEGES NEEDED: <udl-white>View Payers<udl-white> | <udl-white>Add Payer<udl-white>

ADD PAYERFILTER | DELETING AN ORGANIZATION PAYER | MEDICARE DEMAND DENIAL PAYERMEDICARE DEMAND DENIAL SIMULTANEOUS PAYER | MEDICARE DEMAND DENIAL NO PAY | SUBMENUS | QUIZ 

To add an organization payer, go to:

  1. Resources
  2. Organization Payers

ADD PAYER <returntomenu>menu ↑<returntomenu>

To add a payer, click on <icon-greenplussign>xxx<icon-greenplussign> <udl-orange>Add Payer<udl-orange>

To add a new payer, click on the <icon-greenplussign>xxx<icon-greenplussign> <udl-orange>Add Payer<udl-orange> link.

Enter the required information for the payer and click <btnw>    Add    <btnw> </btnw></btnw>

Select the drop down <btn>   [Select an Agency Type]    ▾   <btn> to the right of "Restrict Payer To Agency Type" to restrict Organization payers that are set up for you by Agency type. Agency Types include: Home Health, Hospice, Palliative Care and Private Duty. For example: you have both a hospice and home health agency. You bill Medicare for services provided through each type of Agency. By attaching the agency type to these 2 payers, this will prevent you from assigning the Hospice Medicare payer to a Home Health Agency patient as well as prevent you from assigning the Home Health Medicare payer to a Hospice patient.

You can search payers, by Payer Name...

FILTER <returntomenu>menu ↑<returntomenu>

You can filter by selecting the drop down <btn>   All     ▾   <btn> under Payer Category...

Or you can filter by selecting the drop down <btn>   All     ▾   <btn> under Status.

To view a specific payer, click on either the link for the payer <udl-orange>ACS, Inc (NM)<udl-orange> or

the magnifying glass <icon-magnify>xxx<icon-magnify> icon.

This will take you to the Payer Master File.  Click here to learn more about the Organization Payer Header

DELETING AN ORGANIZATION PAYER <returntomenu>menu ↑<returntomenu>

You can delete an organization payer when you meet specific criteria.   Before the “Delete” <icon-trashcan>xxx<icon-trashcan> icon displays for the payer you want to delete, you must make sure that:

After you inactivate the payer (which can be done by entering an “Organization Payer End Date” from the Settings tab) and you have deleted all information from all other tabs (as listed above), you will see the “Delete” <icon-trashcan>xxx<icon-trashcan> icon on the Organization Payers listing for this payer.  Select this icon to remove this payer from your Organization Payers file.  

Note: If you attached the payer to a Patient, scheduled services using the payer, verified and billed services to this payer, you will not be able to delete the payer even though the icon is available.  You can only make this payer “inactive” so that it is no longer available for you to use.

MEDICARE DEMAND DENIAL PAYER <returntomenu>menu ↑<returntomenu>

On occasion, you may need to generate a demand denial bill and denial response for a Medicare patient before you can bill another payment source or notify the patient that services are not covered by Medicare.    Medicare demand denials use a different payer than your Medicare Part A claims. You use this payer when you need to request this type of denial from Medicare.

Use the following path to add this new payer to your Organization payer file:

To obtain a demand denial, attach this payer to the Patient Encounter as follows:

To bill a different payment source:

After you have both payers set up, schedule all services to the Medicare payment source and assign services to Associates.   Then, verify all scheduled services to generate the bill for the demand denial you are requesting.  

After you receive the denial response, reassign all the services to the correct primary payer.

MEDICARE DEMAND DENIAL SIMULTANEOUS PAYER <returntomenu>menu ↑<returntomenu>

On occasion, you may be able to create a demand denial bill for a Medicare patient and bill another payment source at the same time.    Some payers will allow you to bill without the denial response but expect you to have it on file for a Medicare patient if/when they request it.  

This type of demand denial uses a different payer than your Medicare Part A claims.  You use this payer when you need to request this type of denial from Medicare AND bill the other payment source at the same time.

Use the following path to add this new payer to your Organization payer file:

To obtain a demand denial while billing another payment source, attach this payer to the Patient Encounter as follows:

Some payers may require a demand bill for each billing period.  You can access the “Medicare Demand Denial Simultaneous” payer for the Patient and generate a new one for each billing timeframe.    

To bill a different payment source:

After you have both payers set up, schedule all services to the payment source you plan to bill (not Medicare) and assign services to Associates.   Then, verify all scheduled services to generate the bill for the primary payment source.  

After you receive the denial response, reassign all the services to the correct primary payer.

MEDICARE DEMAND DENIAL NO PAY <returntomenu>menu ↑<returntomenu> 

You have a global payer for your individual MAC (Medicare Administrative Contractor) that lets you submit a Medicare demand bill for no payment at the same time you bill another payment source.  If you need to obtain a a denial from another payment source that expects you to have the Medicare denial as well, you can add this payer to your Organization, attach the this payer to a Patient and create this type of denial request. Processes you use to create this type of denial request include:

Adding Demand Denial Payer to your Organization

Before you can create the denial request, you must first add the "Medicare Demand Denial Simultaneous No Pay" global payer to your list of Organization payers as follows:

The Organization Payer detail information/tabs display. Make sure that you complete the <udl>Settings<udl> tab, Identifiers section with your National Provider Number, Provider Number (PTAN) and Tax Identification Number.

Note: All payer invoicing requirements and rules needed for billing are part of the global payer that you added.

Attaching Demand Denial Payer to Patient Encounter

For Patients that have payment sources that require this type of denial, you can add this payer as follows:

The <udl>Payers<udl> tab redisplays showing the payer you added.

Note: Be sure that you add the primary payer as you are scheduling/verifying all services for that payer.

Creating Demand Denial Payer

When you need to create a "Medicare Demand Denial Simultaneous No Pay" invoice, use the following path:

The "Demand Bill - No Pay" invoice will generate based on the date range you entered. The invoice will include all the appropriate information required for the demand denial. Remarks you entered when creating the the "Demand Bill - No Pay" will show up on the invoice along with Condition Code "21-Billing for Denial Notice".

Interactive Tutorial