Insurance Payer ID’s

March 2023

So, you’re sending your claims electronically. Excellent! But are they going to the insurance company you intended? Just like a physical address, all insurance carriers have their own unique payer ID for electronic claim submissions. This payer ID is often listed right on the member’s insurance card to make it easier. But here’s the catch: payer ID’s differ depending on the clearinghouse you are using for submission. And, spoiler alert, electronic claim attachments often have their own ID as well.

Understanding Payer ID’s

Do you have a current list of electronic payer ID's from your specific clearinghouse? At the end of the day, it is the clearinghouse that forwards your claims to payers not your software. So, understanding how the clearinghouse perceives the routing of your claim is important. A direct login to your clearinghouse to see where claims will be sent via the payer ID you selected is a game changer – it also gives greater insight into claim rejections (for more on this read our January Blog: Claim Rejections).

The payer ID listed on a patient’s insurance card does not mean it is the correct payer ID for that insurance company with your clearing house. For clarity, reach out to your software vender to learn what clearing house you use in conjunction with your software. Then reach out to the clearing house directly for specific resources to help you manage your specific payer ID’s.

Electronic Attachments

Electronic dental claim attachments are also often managed by a third-party vendor and can have their own ID’s that map where the attachment is routed. It is often assumed that the claim and attachment get sent together but that is typically not the case. The claim is sent via your clearing house and the attachment is sent via your attachment vendor, each managing their own set of payer ID’s that map to the insurance company. Make sure the attachment is being sent to the same insurance company as the claim!

Managing Insurance Profiles

So, you have your clearing house payer ID’s and you have your electronic attachment ID’s…now it’s time to bring it all together in your database with your insurance carrier/plan profiles.

Database insurance carrier/plan profiles are often created on an as-needed basis, which over time means that your list of profiles grows and grows making it harder to discern the differences of one from another.

Here are a few tips:

1. Understand how your software utilizes the information stored in your insurance profiles

2. Develop a protocol (including the name format) for how a new profile is created and managed

3. Create clear training guidelines for new staff

4. Periodically check your profiles for outdated information

5. Use your claim rejections to help identify profile issues and errors

Feeling like it’s time for a billing tune-up? Dental Billing & Consulting Professionals provides tailored consulting services to meet your specific needs. Call or text us any time at (860) 435-7344 to learn more.