When you set up your payers, you enter basic information, along with reminders, billing settings, notes, and document settings. After you add your payers, you will assign them to your patients to record coverage information, create claims for billing, and keep track of payments on claims. You can set up and manage your payers in the Payers section of the Admin tab.
NOTE: If you want to receive ERAs through Fusion for a new payer, please contact Support about enrollment.
Jump to Section: [Add & Edit a Payer] [Payer Information Tabs] [Merge Duplicate Payers] [Delete a Payer]
Add & Edit a Payer
- Click the Admin tab at the top of the screen.
- Click Basic Setup in the menu on the left.
- Click Payers.
- In the lower right, click the Add(+) Payer button, or click on the name of an existing payer to edit that payer.
- Enter Payer, Reminders, Billing, Notes and Documents information using the tabs at the top of the Add Payer window.
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Click the Save Payer button.
Payer Information Tabs
Click the sections below for more information about the tabs in the Add Payer window.
Payer Tab
Name: The payer's name, which may also be used on claims.
Type: When used with billing, the payer's type controls which option is selected in box 1 of the claim form.
Remitter: The remitter controls where a claim is sent when it is submitted electronically. If no remitter is selected, claims for this payer will be "Paper Only."
Calendar Year: Indicates whether or not this payer's coverage is on a calendar-year basis. This is for reference only.
Phone/Fax: The payer's fax number can be selected when faxing documents or invoices for a patient this payer is linked to.
Address: The payer's address, which may be used on claims for billing.
Reminders Tab
Co-Signing Frequency: How often users without signoff must get their daily notes co-signed for this payer.
Progress Note Frequency: How often this payer requires progress notes.
Re-Assessment Frequency: How often this payer requires re-assessments.
NOTE: You can leave these blank unless this payer's requirements are different from the global reminder settings in Clinic Options.
Billing Tab
Assistants: If the primary therapist does not have signoff, this determines whether claims for this payer will bill as the assistant or the supervisor. Signoff for each therapist can be changed in Users.
Authorizations: Determines whether this payer's authorizations are calculated by visits or units.
Time In/Out Per Billing Code: Set to Yes if you want to show code times on claims. This lets you add a start and end time to each timed billing code on a daily note, which will automatically appear in box 24: Service Note on claims for this payer.
Calculate Units: Determines how the units for this payer will be calculated. By Total Minutes is based on the CMS 8-Minute Rule. The total units across all timed billing codes for an appointment are calculated by adding the minutes for all timed codes and dividing that by 15. Per Billing Code is based on AMA guidelines. The units for each timed billing code are calculated by dividing the minutes for that code by 15.
Claims: Indicates if claims for this payer should be generated automatically when charges are submitted. If they do not generate automatically, submitted charges will be sent to the patient's billing account.
Accept Assignment: Indicates whether the clinic wants to accept payment on behalf of the patient. This appears in box 27 of the claim form.
Notes Tab
Notes: Use the Notes text field to store additional information about the payer for your reference. Documents Tab
Daily Note Style: Determines whether daily notes for this payer will have the normal SOAP steps or will be abbreviated into a single narrative field. All the payers linked to a patient must have this set to "Abbreviated" to create abbreviated daily notes.
Document Names: If a payer requires specific titles for patient documents, you can assign default Document Names to that payer by selecting items on the Document Name dropdown lists. Selecting a document name will add a custom title to documents of that type for this payer.
Merge Duplicate PayersNOTE: This is permanent! Once payers have been merged, the discarded payer will be replaced on all patients who were linked to it. This action cannot be undone.
- In the lower right, click the Merge Duplicates button.
- Search for and select the Payer to Discard and the Payer to Keep.
- Click the Merge Payers button.
Delete a Payer
You can delete payers that have not been assigned to patients or linked to any claims.
- To the right of the payer, click the delete icon
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- Click the Delete Payer button.
- In the lower right, click the Merge Duplicates button.