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We are currently updating the OP Help Center content for the release of OP 20. We appreciate your patience as we continue to update all of our content. To locate the version of your software, navigate to: Help tab > About.

Insurance Payer Details

Version 20.0

About Insurance Payer Details

Path: Billing tab > Payers button > New or Edit button

The Insurance Payer Details window contains the insurance payer details such as basic information, claims/routings, and contracts.

Insurance Payer Details Map

Number

SectionDescription

1

Basic Information tabThe Basic Information tab contains all the basic details for the insurance payer such as short code, short name, full name, address, contact name, phone number, note, status, start date, end date, fee schedule, and coding.

2

Claims/Routing tabThe Claims/Routing tab sets the insurance payer transaction details.

3

Contracts tabThe Contracts tab lists all the contracts associated with the insurance payer with an effective date and expiration date. You may also attach a contract.

4

Change Merge Code buttonThe Change/Merge Code button opens the Change/Merge Codes form.  This button begins the process of changing the existing insurance carrier short code to a new insurance carrier short code or merging the existing short code with a different existing short code.  This operation will change the existing Carrier Code for all corresponding records in the forms.  It should not be performed while the system is active.

Version 20.1

About Insurance Payer Details

Path: Billing tab > Payers button > New or Edit button

The Insurance Payer Details window is broken up into four tabs: Basic information, Payer Coding Rules, Claims/Routing, and Contracts. These tabs house the payer information as it relates to coding rule, transmitting claims, and verifying eligibility.

Insurance Payer Details Map

Number

SectionDescription

1

Basic Information tabThe Basic Information tab contains all the basic details for the insurance payer such as short code, short name, full name, address, contact name, phone number, note, status, start date, end date, and fee schedule.
2
Payer Coding Rules tabThe Payer Coding Rules tab contains the immunization administration coding rule override for the payer, special vaccine coding rules, special CPT coding rules, and special claim coding rules.

3

Claims/Routing tabThe Claims/Routing tab sets the insurance payer transaction details.

4

Contracts tabThe Contracts tab lists all the contracts associated with the insurance payer with an effective date and expiration date. You may also attach a contract.

5

Change/Merge Code buttonThe Change/Merge Code button opens the Change/Merge Codes form.  This button begins the process of changing the existing insurance carrier short code to a new insurance carrier short code or merging the existing short code with a different existing short code.  This operation will change the existing Carrier Code for all corresponding records in the forms.  It should not be performed while the system is active.
6Save and Cancel buttonsThe Save button is used to save changes or entries made in the Insurance Payers Details window. The Cancel button is used to leave the Insurance Payer Details window without saving any changes or entries.