Adding and Configuring Payer Plans

For each Payer you add to NikoHealth, you can configure:

This article goes over how to setup and manage Payer Plans. If you need help taking the initial steps to configure Payer Details, visit our help article on this topic linked above.

Some Insurance companies have multiple plans associated with them. For example, Aetna might be the primary insurance carrier for a Patient, but the Patient may have Aetna Medicare. While this is a Medicare policy, it still falls under the commercial insurance Aetna, so it can be added under the Payer as a separate Plan.

To add a Plan to a Payer, navigate to the Payer Settings:

Management > Billing Setup > Payers

Select the Payer you're adding the Plan to.

By default, the Payer will open to the Details tab. To add the new Plan, click on the Plans tab and click the Add New Plan button.

Enter the required information on the Plan.

If the mailing address of the Plan's claims is different than the mailing address of the parent Payer, you can enter the Plan's address.

When adding Plans for a Payer, configuring claim options for that Plan is optional. For each Plan under the Payer, you can set up Plan-specific claim options. Or, if you do not set up claim options for a Plan, it will default to the Payer's settings.