This article provides instructions on how to set your payer settings that are used for electronic claim submissions and paper claim processing.
To edit payer settings
Click Management>Billing.
Once you find the payer record, click to open it.
Payer Details
Here you can add or edit:
a. Payer name
b. Address
c. Clearinghouse
d. Pricing Group
e. GL Account
All commercial payers should be set to submit through ChangeHealthcare.
For any workers comp or property & casualty payers please make sure your account is configured to submit claims through Jopari or Carisk. Please check with your account manager or contact support@nikohealth.com for additional instructions.
Claim Options
Payer ID: This is the ID for 837 claim submissions and should be the ID defined by the clearinghouse where this claim is being sent.
Remittance ID: This is the ID used by the payer on 835 electronic remittances and is used by NikoHealth to match the incoming ERA to the payer. In most cases this ID will be the same as used for the Payer ID.
Electronic Eligibility ID: This is the ID used for electronic insurance eligibility and should be the ID defined by the clearinghouse. In most cases this ID will be the same as used for the Payer ID.
Attachment ID: For payers that accept electronic document attachments this is the ID used to electronically route the 275 attachment.
Automatically Submit Recurring Invoices: You can set the preference to auto submit recurring rental invoices automatically by toggling it on/off.
Auto Post ERA: You can set the preference to auto post electronic remittances by toggling it on/off.
Auto Balance Transfer to Patient: You can set the preference to transfer a remaining invoice balance to the patient by toggling it on/off.
Claim Filing Indicator: You can select the appropriate payer type from the drop down selection and must be properly defined to avoid any clearinghouse rejections.
Medicaid Carrier Code: This is a unique carrier code that may be needed to identify the payer when submitting claims that require a coordination of benefits.
Claim Office Number: This is situational and should only be used when required by the payer as an additional identifier.
CMS 1500 Form Settings: You can select the appropriate setting from the drop down and this is used to populate BOX 1 of the CMS 1500 form when printed.
When adding plans for the payer, the payer plan claim options will default to the payer settings defined unless otherwise set. You do not need to set any plan options as it will default to the payer settings.