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. Payers may be entered
in any sequence and displayed in any sequence. Required for all Other
Payers.
Payer Type: A code identifying the type of Payer. Enter or select a value from the list of available codes.
Other Payer Paid Amount: 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 control number of the other payer.
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.
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.
Primary ID: The Other Insured Identifier as assigned by the Payer. This is required when entering the Subscriber for the Other Payer.
Address Line 1/2: The street address of the Subscriber, if known.
City: Enter city name of the Subscriber.
State: State in which the Subscriber lives. Select value from the list of available valid state abbreviations, defaults to 'NY'.
Zip Code: Enter the postal Code associated with the Subscriber's address.
Country: Country in which the Subscriber lives. 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.
Group Number: Enter the Subscriber’s group number for the other payer when applicable.
Group Name: The Group Name associated with the Group Number above.
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 codes and reason codes are from the remittance of the other payer.
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. 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.
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.
Patient Signature Source: Enter or select the Patient Signature Source Code, indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider. An entry 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. This value is required if an Other Payer Name is selected.
Remaining Patient Liability: This is the amount the provider believes is due and owing after the Other Payer’s adjudication.
Non-Covered Charge Amount: Enter the dollar value of the claim in this field if the other payer was not billed, and documentation is on file that the other payer would not have paid the claim.
Once all the information for the Payer has been added, another payer may be added 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 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.
