RevNet User Guide - Payer Information

Payer Information

Navigate to: Setup -> RevNet-> Payer/Provider -> Payer

Payer

The Payer page shows all payers that have been added for the agency. This page defaults to Add Payer. To see a list of all payers, click [Show Payer Grid...].

This will show the list of Payers Name and the Payer Organization.

Add Organization

Before a Payer can be added, the Organization must be added first. The Add Organization page can be accessed by navigating to Contact Mgmt -> Contact Management -> Organization or by clicking Add Organization.

Enter the Organization Name and Type. Types include Collection Agency, Multi-Agency Organization, Other, Payer. Complete other information as known for the organization.

Click Save when complete.

Add New Payer

This page defaults to Add Payer. Complete the information below and click Save Payer.

Name: Name of the Payer

Organization: Organization for the Payer added previously

Group: Select the Payer Group that this payer should be associated with. Payer Groups are configured in Setup -> RevNet -> Payer/Provider -> Payer Group.

Is Medicare/Medicaid/Self-Pay: Check these boxes if the Payer added is considered Medicare, Medicaid or Self-Pay.

Default Medicare/Medicaid/Self-Pay: Check these boxes if the Payer is the Default Medicare, Medicaid or Self-Pay Payer. If crew add a Medicare or Medicaid number on the ePCR, this payer will be added to the Patient Information Insurance tab.

Final Payer: Check this box if this should be considered a Final Payer, meaning once an invoice reaches this payer, there can be no more Balance Forwarding.

Assigned Providers

Assigned Providers allows for multiple providers to be added to the same payer. Each Payer/Provider is unique. To Add Provider, select the Provider from the list and click Save. If the agency is only has one provider, this will be done automatically.

    Payer/Provider
   

The Payer will show a $ indicator if all billing data is completed. $ will indicate additional information needed and $ will indicate all billing data complete.
   

Details

The Details page show details regarding the Payer/Provider.

 

Regional Payer: Use the Search box to find the Regional Payer. This list is provided by Zirmed and will include the Payer ID included in the EDI Files sent to ZirMed.

Enrollment Required: These checkboxes will display a check if the Payer required enrollment through Zirmed. Example: A check will be seen in Remits to indicate that the provider must enroll with the payer/Zirmed to receive electronic remittances.

Uses Medicare Fee Schedule: Check this box if the payer uses the Medicare Fee Schedule for Ambulance Billing. If the payer uses Fee Schedule, a Rate Group will not need to be added.

Rate Group: Select the Rate Group for this payer. A Rate Group must be selected from the list in order to bill this payer.

Billing Contact: Select the Billing Contact for the Agency. This list is based on the Contacts added on the Organization in Contact Management.

Days Eligibility Response is Valid: The number of days and eligibility response is valid for. Example: If 30 is entered for an Eligibility request on 5/1, any call that needs to be billed in the next 30 days for a specific patient, eligibility would not need to be checked again.

Organizations:

Billing: Select the Billing Organization for this payer. If left blank, the billing provider loops will not be included in the EDI File.

Pay to Provider: Select the Pay to Provider Organization for this payer. This would be used if all checked and remittances should be sent to a location other than the agency, for example a Lockbox.

Rendering Provider: Select the Rendering Provider Organization for this payer. If left blank, the rendering provider loops will not be included in the EDI File.

Contacts

The Contacts page shows all contacts for the provider and the payer organization.

 

Billing Options

The Billing Options page show the available billing options for the Payer/Provider.

Invoice Type: 1500 (08-05) 537 5010 EDI, 1500 (08-05) 537 4010 EDI, 1500 (08-05) Paper, Facility Billing Export, Generic, Statement, UB04 837 4010 EDI, UB04 837 5010 EDI, UB04 Paper. Select the Invoice Type that should be submitted to the payer for Primary submissions. Most payers require 1500 forms for Ambulance billing. If submitting claims to Zirmed, select one of the EDI Options.

Subsequent Invoice Type: Options for Subsequent Invoice Type are the same as Invoice Type. Select the Subsequent Invoice Type that should be submitted to the payer for non-Primary (Secondary, Tertiary, etc) submissions.

Batch Submission Type: Submit Electronically or Download and Submit Manually. Select the Batch Submission Type for this payer. Select Submit Electronically if claims will be sent to Zirmed. Select Download and Submit Manually if this will be handled by agency staff.

Method: Method 1 All Inclusive, Method 2 Mileage Separate, Method 3 Supplies separate, Mileage and supplies separate. Select the Method for this payer.

Invoice Rate: Usual and Customary or Negotiated. This is the rate that appears on the claim.  This will usually be the Usual and Customary Rate.

Statement Delivery Method: Print or Electronic. Select Print if Statements for this payer will be printed by the agency. Select Electronic if Statement batches should be sent to Zirmed.

NY Medicaid Prior Auth: NPI or Provider ID. Select what should be included on the NY Medicaid Prior Auth Report/Export.

Mileage Detail Option: No Rounding/Decimal Level or Round Up/Whole Number. Select the option for this payer. Select No Rounding/Decimal Value if the exact mileage should be included on the mileage detail line. Select Round Up/Whole Number if Whole Number should be included on the mileage detail line.

Claim Level Mileage Option: No Rounding/Decimal Level or Round Up/Whole Number.. Select the option for this payer. Select No Rounding/Decimal Value if the exact mileage should be included for the claim level mileage information. Select Round Up/Whole Number if Whole Number should be included for the claim level mileage information.

Subsequent Claim Level Mileage Option: No Rounding/Decimal Level or Round Up/Whole Number.. Select the option for this payer when the payer is not the Primary Payer. Select No Rounding/Decimal Value if the exact mileage should be included for the claim level mileage information. Select Round Up/Whole Number if Whole Number should be included for the claim level mileage information.

Group Service By: HCPCs/Service Date (Use Initial Modifier) or HCPCs/Service Date/Modifiers. When grouping Bill Records, determine how the line items should be grouped.

Include Pick-up Address as Facility Address: Check this box to use the Pick-up Address on the ePCR as the Facility Address in the Bill Record.

Include Origin/Destination on Generic Invoice/Statement: Check this box to show the Origin and Destination on the Generic Invoices and/or Statements.

Exclude Payer Name: Check this box to not include the payer name on the Printed 1500s.

Exclude MOA Codes: Some Payers do not want to receive MOA (Medicare Outpatient Adjudication) Codes. This will exclude them from secondary/teritary invoices for the payer.

Accept Allowed Amounts: Check this box to accept allowed amount from the payer. Selecting this will automatically adjust the rate of the invoice down to the Max Allowed Amounts included on the remittance.

Accept Payment in Full: Check this box to indicate payment received on invoices for this payer will be considered Payment In Full. If this is checked, an adjustment will be created to mark the invoice as paid.

Allow Auto-Eligibility checking: Check this box to allow RevNet to automatically check eligibility on bill records in Payer Verification. This works in conjunction with "Days Eligibility Response is Valid".

Exclude Pick Up address from FL 32 in 1500: Check this box to not include the Pickup Address in FL32 on the 1500 claim form.

Signature Required: Check this box to require Patient/Authorized Representative signature is on file prior to sending claims.

Ordering Facility Required (Non-EMG): Check this box to add a billing check to confirm that the Ordering Facility is entered on the Bill Record for Non-Emergency calls.

Ordering Global Facility Required (Non-EMG): Check this box to include the Ordering Facility in the EDI Files.

Pick Up County Required (Non-EMG): Check this box to add a billing check to make sure the Incident Address County is completed on the Bill Record for Non-Emergency calls.

Include Vehicle License Plate Number: Check this box to include the License Plate Number of the Vehicle on the claim and in the EDI Files.

Include Employee Driver's License: Check this box to include the Driver's License Number of the Driver on the claim and in the EDI Files.

From/To Facilities Required (Non-EMG): Check this box to add a billing check to make sure the Transport To and Transport From Facilities are completed on the bill record for Non-Emergency calls.

Prior Auth # Required (Non-EMG): Check this box to add a billing check to make sure there is a Prior Auth # on the claim prior to billing for Non-Emergency Calls.

Do not use Zip Code as Prior Auth #: Check this to not use the Zip Code as the Prior Auth #.

EDI Settings

EDI Settings are included in the EDI File that is downloaded and manually sent or automatically sent to Zirmed. This needs to be completed if the Invoice Type in Billing Options is an EDI invoice type.

NProvider Option: NPI Only, NPI and Legacy IDs, Legacy IDs Only. Select the option for what to include in the EDI File. This will usually be NPI Only.

NProvider ID: Enter the NPI for the Provider.

Provider #: Enter the Provider # for the Provider.

Provider # Type: Select the Provider # Type for the Provider ID entered.

Submitter ID: May be used during Payer Setup. Not required when using Zirmed.

Sender ID Type: May be used during Payer Setup. Not required when using Zirmed.

Receiver ID: May be used during Payer Setup. Not required when using Zirmed.

Receiver ID Type: May be used during Payer Setup. Not required when using Zirmed.

AppSenderCode: May be used during Payer Setup. Not required when using Zirmed.

AppReceiverCode: May be used during Payer Setup. Not required when using Zirmed.

Submitter Etin: May be used during Payer Setup. Not required when using Zirmed.

Receiver Etin: May be used during Payer Setup. Not required when using Zirmed.

Facility #: Enter the Facility # for the Provider. This should only be completed as requested by the payer. This is not normally completed.

State License #: Enter the State License # for the Provider. This should only be completed as requested by the payer. This is not normally completed.

Provider Comm #: Enter the Provider Comm # for the Provider. This should only be completed as requested by the payer. This is not normally completed.

Provider Site #: Enter the Provider Site # for the Provider. This should only be completed as requested by the payer. This is not normally completed.

Location #: Enter the Location # for the Provider. This should only be completed as requested by the payer. This is not normally completed.

RP Option: Enter the Rendering Provider Option for the Provider. This should only be completed as requested by the payer. This is not normally completed.

RP Primary ID: Enter the Rendering Provider Primary ID for the Provider. This should only be completed as requested by the payer. This is not normally completed.

RP Primary ID Qualifier: Enter the Rendering Provider Primary ID Qualifier for the Provider. This should only be completed as requested by the payer. This is not normally completed.

RP Secondary ID: Enter the Rendering Provider Secondary ID for the Provider. This should only be completed as requested by the payer. This is not normally completed.

RP Secondary ID Qualifier: Enter the Rendering Provider Secondary ID Qualifier for the Provider. This should only be completed as requested by the payer. This is not normally completed.

x12 Response: Yes or No. Indicate if a Functional Acknowledgement x12 Response file is wanted.

Claim Filing Indicator Code: Select the appropriate Claim Filing Indicator Code for the payer.

Cross-Over Payer ID: Select ALL appropriate Cross-Over Payer IDs for this payer. This is need to automatically select the appropriate agency payer when Medicare Crosses Over the claim to a secondary payer. Medicare will automatically balance forward claims to secondary payers when included in the original EDI file. Having this setup assists RevNet to select the correct payer when the ERA is imported.

Insurance Type Code: Select the appropriate Insurance Type Code for the payer.

Services

This will show the Services for the Rate Group added on the Details page.

 

Mileage

This will show the Mileage for the Rate Group added on the Details page.

 

Medications

This will show the Medications for the Rate Group added on the Details page.

 

Supplies/Other

This will show the Supplies/Other Items for the Rate Group added on the Details page.

 

Links

This will show links added for this payer. Example would be an external website to check eligibility.

 

Statements

The Statements page allows for entering multiple Dunning Language for Statements that are sent to the patient. This is normally seen on the Self-Pay payer. Each time a statement is sent to the patient, the appropriate Dunning Language will be included on the statement..

To Add Dunning Language

Type the Message required and click Save Message. If the message is intended to be the Final Notice check the box and click Save Message.

Note: Once a Final Notice has been sent, the invoice can be sent to Collections..