Overview
Setting up and correctly configuring your Payers in NikoHealth is the foundation for clean eligibility, authorizations, and billing workflows.
After adding new Payers to NikoHealth, you'll have the ability to configure important Payer information about the Payer including Payer Details, Payer Plans, and Payer Rules.
This video covers the entire process of adding a new Payer and then configuring Details, Plans, and Rules for that Payer. For a deeper understanding of each of these steps, visit the help articles linked above.
Adding a New Payer
To add a new Payer, navigate to:
Management > Billing Setup > Payers
In this Payers queue, you'll see a list of any Payers you've already added to the system. You can click on a Payer to view more information including the Payer's Details, Plans, and Payer Rules.
To add a new Payer, click on the blue NikoHealth action button in the top right corner.
In the popup box, add the Payer name and ID. Be sure to review important information about Payer IDs below.
After clicking Next, you'll be taken to the new Payer screen where you can configure important information about the Payer. Visit our help articles on:
Understanding Payer ID
The Payer ID will be used for any Electronic Claims you set up. We strongly encourage our clients to only have one payer ID per payer in the system. You can create multiple plans under a Payer and roll them up to a single Payer with a single Payer ID.
(For more information on adding Plans to a Payer, visit our help article on Adding and Configuring Payer Plans)
Payer IDs in NikoHealth are the codes that clearinghouses use to route electronic claims to the correct Payer. Because NikoHealth can integrate with multiple clearinghouses, each Payer’s "Payer ID" must be pulled from the payer list or portal for the specific clearinghouse connection you’re using, and then entered accurately into NikoHealth. These IDs can differ by clearinghouse or claim type, so it's important to be accurate. If the wrong Payer ID is used, claims can be rejected or never reach the Payer. So always confirm the correct Payer ID with the clearinghouse, enter it into NikoHealth exactly as provided, and keep it updated if the clearinghouse changes their routing. For more information, visit our help article on Clearinghouse Integrations.
Helpful Links