Refresher: Insurance Payer ID’s
June 2024
It’s been just about 4 months since the CHC/Emdeon outage. Hopefully, you’re sending the majority of your claims electronically again. Phew! But are they going to the insurance company you intended? Payer ID’s differ depending on the clearinghouse you are using for submission – and you just switched to a new clearinghouse. Time for a refresher on setting up and reviewing your database insurance profiles to make sure they are up-to-date.
Key Questions
How is your practice management software handling the integration with the new clearinghouse? (For example, WinOMS has handled the switch to a new clearinghouse on the backend without the user needing to make any payer ID updates)
Have you also switched to a new vendor for electronic dental claim attachments?
Electronic Payer ID’s
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. 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 clearinghouse. Do you have a current list of electronic payer ID's from your specific clearinghouse?
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 clearinghouse 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
This transitional time lends itself perfectly to a database insurance carrier/plan profile clean-up! Designate a team member to review all existing insurance profiles and ensure all address, payer ID, attachment ID information is up-to-date given clearinghouse changes.
If you are still mailing medical claims – many software are still working on integrating this functionality – you will need to perform another profile clean-up once you have those new payer IDs too.
And, as always during any time of transition, be vigilant of claim rejections and/or changes in claim processing that may indicate a need for further clean-up or clarity with your new clearinghouse.
General Payer ID Guidance
For more general payer ID guidance, please read our March 2023 Billing Blog
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.