Enter Other Payer
Enter Other PayerIn addition to NY Medicaid, you may enter additional payers who are responsible for this claim. Remember that all elements marked with an asterisk (*) are required when entering a Payer. Not all claims will have Other Payer information. Note: A maximum of 10 Other Payer records may be entered per claim.
Other Payer Name: Select the name of the desired payer from the provided list. If the Other Payer you are looking for is not listed, contact your Administrator to add the Payer to the Support File of valid Payers. Required for all Other Payers.
Payer Sequence Number: Select the value that represents the order in which payment was received from other payers. This will determine in what order the payer is applied to the value of the claim. Payers may be entered in any sequence and displayed in any sequence. Required for all Other Payers.
Other Payer Paid Amount: The amount this payer has paid to the provider towards this bill. This field is required when this payer has adjudicated the claim. If the Other Payer denied the claim, enter 0. If the Other Payer has not adjudicated the claim, leave blank. If a value is entered, the Date Claim Paid must be entered as well.
Other Payer Claim Control Number: Enter the claim identification number this payer has assigned to the claim.
Remaining Patient Responsibility: This is the amount the provider believes is due and owing after the Other Payer’s adjudication.
Total Non-Covered Amount: Enter the dollar value of the claim in this field if the other payer was not billed, because documentation is on file that the other payer would not have paid the claim.
Date Claim Paid: Date on which the Other Payer Paid Amount was received. This date may not be greater than the current date. The format is: MM/DD/YYYY and may either be entered in the field or selected from the calendar available by pressing the button to the right of the field.
Covered Days: The number of full days that are eligible for reimbursement by the Other Payer.
Last Name/First Name: If entering an Other Payer, you must enter the First and Last Name of the Subscriber for the Payer. The Subscriber may or may not be the Client.
Member ID: The Subscribers ID as assigned by the Payer. This is required when entering the Subscriber for the Other Payer.
Address Line 1/2: Enter the street address of the subscriber.
City: Enter the city name of the subscriber.
State: Enter the state of the subscriber.
Zip Code: Enter the Zip of the subscriber.
Country: Country in which the Subscriber lives, if known. Select value from the list of available countries, defaults to 'US'.
Relationship: Code indicating the relationship between the Client/Patient and the Subscriber for this Payer. Enter or select a value from the list of available codes. A relationship is required if a Subscriber is entered.
Payer Type: Code identifying the type of payer. Enter or select a value from the list of available codes. A Claim Filing Indicator is required if a Subscriber is entered.
Group Number: Enter the Subscriber’s group number for the other payer when applicable.
Group Name: Enter the Subscriber’s group name for the other payer when a group number is not present, but the group name is.
If the other payer reported claim adjustments at the claim level, enter the adjustment information here. Otherwise, this information will be blank.
Claim
Adjustment Group: Enter the Group Code as received from the other
payer. A maximum of 5 Claim Adjustment Groups are allowed per claim and
the values are to be entered.
Reason Code: Enter the Claim Adjustment Reason Code as received
from the other payer. This is directly correlated to the Claim Adjustment
Group. The Claim Adjustment Group/Reason Code combination may not be entered
more than once. If an Adjustment Amount or Adjustment Quantity is entered,
a Reason Code is required.
Adjustment Amount: Enter the Adjustment Amount as received from
the other payer. An Adjustment Amount is required when a Reason Code is
entered.
Adjustment Quantity: Enter the Quantity Adjusted as received from
the other payer.
Assignment of Benefits?: The Benefits Assignment Certification Indicator. 'Yes' indicates insured or authorized person authorizes benefits to be assigned to the provider while 'No' indicates that no authorization has been given. This value will default to 'Yes' and is required if an Other Payer Name is selected.
Release of Information?: Indicates whether the provider has a signed statement by the patient authorizing the release of medical data to other organizations. You must enter or select a value if an Other Payer Name is selected.
Once you have entered all the information for the Payer, you may add another payer by clicking the Next Payer>> control at the top or bottom of the tab. This will return you to the top of the page with all the values cleared out and a new Payer Sequence Number listed at the top of the page. Clicking View All Other Payers will display the Other Payers Summary page.
Click here for the controls located at the bottom of the page or continue to the Service Line(s) tab.
