Sandata Agency Management 10-System Payor Window

The General tab displays general information, Payor options and restrictions, billing scripts, and provider numbers.

The General section of the General tab displays basic Payer contact and billing information.

Field	Description
Name	Use this field to enter the Payer’s name.
Phone	Use this field to enter the Payer’s phone number.
Fax	Use this field to enter the Payer’s fax number.
Scheduled Week End	Use this dropdown to select the Payer’s week ending date. When the Payer already has schedules in the system, this field is not editable.
Live-In Equiv	Use this field to set the Payer’s number of hours paid during a live-in service to limit overtime and prevent overnight pay.
Reduce Hours	Select this checkbox to enable reduced hours for a visit.
Third Party ID	Use this field to enter the ID number of the third party that the Payer uses to provide live in service.
Effective	Use this field to select the third-party service starting date.
Expiration	Use this field to select the third-party service ending date.
Revenue Source	Use this dropdown to select if the Payer is Contract or Direct.
Third Party Company ID	Use this dropdown to select the third-party company name.
Dept Code	Use this field to enter the third-party company department code.

Address

The Address section of the General tab displays the physical address information for the Payer.

Field	Description
Address	Use this field to enter the Payer’s address.
City	Use this field to enter the Payer’s city.
State	Use this field to enter the Payer’s state.
Zip	Use this field to enter the Payer’s zip.

Scripts

The Script section of the General tab displays details about custom scripts that have been developed to assist with invoice and call processing.

Do not change the Billing and Event field custom scripts without contacting your implementation specialist.

Field	Description
Billing	Use this dropdown to select a billing script to use for the Payer.
Event	Use this dropdown to select an event script to use for the Payer.

Billing

The Billing section of the General tab displays Payer required information for billing a Client.

Field	Description
Method	Use this dropdown to select the method of billing for the Payer.
Transport	Use this dropdown to select if the claim will be sent out as paper or electronic.
Grouping	Use this dropdown to select the Payer’s date range limitations.
Billing Freq	Use this dropdown to select the Payer’s billing frequency.
Bill Code	Use this field to enter the Payer’s bill code.
Requires a Customer Number	Select this checkbox to require a Customer Number be added for the Client.
No. Mask	Use this field to enter the character length for the Customer Number.
Requires a Medicaid ID	Select this checkbox to require a Medicaid ID number be added to the Client.
Med ID Mask	Use this field to enter the character length for the Medicaid ID number.
Primary Diagnosis Required	Select this checkbox to require a Primary Diagnosis be added for the Client.
Requires Physician for Billing	Select this checkbox to require a Physician be added to the Client.
Requires Physician/NPI for Billing	Select this checkbox to require a Physician and National Physician information number be added to the Client.
Hold Split Shift Billing	Select this checkbox to hold billing for split shift visits for the day if any of the visits are not in confirmed status.
Requires Medicare Place of Service	Select this checkbox to require a place of service be added for a Client.
DOB Required	Select this checkbox to require a date of birth be added to the Client.
Ignore Weekend Split	Select this checkbox to not split billing events on weekends.
Unit Length	Use this field to set the length of a unit for the Payer. Standard is 1 unit = 15 minutes.
Unit Rounding	Use this dropdown to round units to the nearest whole number. Example: 4.36 units rounds to 4 units.
Minimum Units	Use this field to enter the minimum number of units required to bill a Payer.

Options - General Tab Closed

The Options section of the General tab displays additional Payer billing and Client settings.

Field	Description
Require Auths?	Select this checkbox to require an authorization to schedule or bill any visits and to require that any schedule duration exceeding the authorization must be confirmed by someone with billing admin permissions.
Active	Select this checkbox to indicate that the Payer is active.
Enforce Signatures	Select this checkbox to require that claims created without a signature on the 485 document can only have their invoice created by someone with the correct billing permissions.
Bypass Order Validations	Select this checkbox to allow users to save an order without a frequency and create schedules for Clients without the matching order.
Assign Claim Ref to Line Items	Select this checkbox to display the authorization reference number on the invoice.
Split Invoice By Service	Select this checkbox to confirm one invoice per service. If this checkbox is unselected, schedules for services with the same authorization number are pulled into the same invoice for the date range and billing script specified.
Manager Must be R.N.	Select this checkbox to indicate that users can only assign Managers/Coordinators to a Staff Member/Client when the manager has an assigned position that has this checkbox selected.
Truncate Authorization	Select this checkbox to only display authorization numbers before the dash on the invoice. If unselected, the full authorization is displayed.
Use CMS Discharge Codes	Selecting this checkbox to indicate that when discharging a Client, both the CMS Discharge Codes defined by Medicare and the agency defined Discharge Reason Codes are displayed. If the checkbox is unselected, only the agency defined Discharge Reason Codes display when discharging a Client.
Alert on replacements over threshold	Select this checkbox to provide an alert when a scheduled replacement is over the schedulable threshold.
Is Consumer Directed	Select this checkbox for Payors that do not create schedules prior to the visit.
Allow Admit Type edit for locked clients	Select this checkbox to allow users with the appropriate permissions to be able to edit the admission type for locked Clients.
Use OMIG Reason Codes
Concurrent Mutual Scheduling %	Select this checkbox to choose the percentage to be billed on a mutual case where 2 schedules are at the same time with one staff member. This prevents billing the full amount for both visits since they happened together.
Do NOT auto write off CARC codes 42/45
Auto-discharge clients w/o active auths	Select this checkbox to automatically discharge Clients whose authorizations have ended or expired.
Auto-discharge Reason	Use this dropdown to select the reason code to be used when Clients are automatically discharged for an expired or ended authorization.
Show Wkly Auths w Daily Limits	Select this checkbox to show daily allocations for authorizations with limitation by week.
Allow Exporting	Select this checkbox to allow electronic billing to be exported to the Payer.
Require Service Description
TN Consumer Directed
Use Proposed Times for Actual	Select this checkbox for Payers not using Electronic Visit Verification to have the proposed schedule times counted as the actual schedule times and have the visits confirmed after the schedule time has passed.
Bypass NPI Validations for Export?	Select this checkbox to prevent National Provider Identifier (NPI) validation during the export.
Use Staff NPI	Select this checkbox to automatically include a staff member’s NPI number in electronic invoices. To enable this, the Payor Format must include a NPI number and the This payor required Rendering Provider in the 2420A-Loop checkbox must be selected on the EDI Settings tab.
Trim Invoice Bill Dates	Select this checkbox to display the first and last dates of service on the invoice. If the checkbox is not selected, the date range on the Billing Review window under Main Menu > Billing during invoice creation is displayed.
Allow Mass Edit of Clients	Select this checkbox to allow users with the correct permissions to mass edit a Client assigned to multiple schedules from the Schedule Overview window under Main Menu > Scheduling.
Use Taxonomy Code	Select this checkbox to include the taxonomy code from the Provider tab on electronic invoices for this Payer.
Allow Manual Sched Gen	Select this checkbox to allow users with the correct security permissions to generate schedules from the permanent template on a Locked Client.
POC Acknowledgement
Allow Submission of Zero Balance Invoices
Mobile App Enabled must use mobile device
Allow Schedule Split Functionality	Select this checkbox to allow the splitting schedules at midnight.
Access Invoice from Schedule	Select this checkbox to enable a link to the invoice a schedule is attached to from the Schedule details window.
Warn if scheduled for more than 24 hours for a day	Select this checkbox to display a warning when a schedule is added or edited, if scheduled for more than 24 hours for the same service on the same date.
Require schedules to split at midnight	Select this checkbox to prevent billing for any split shift that is missing proposed times.

Provider Numbers Closed

When entered by the agency, the Provider Numbers section of the General tab displays the Payer’s provider numbers including Tax ID, API, NPI and others.

Field	Staff
Location	Displays the location of each Provider number row.
Number	Displays the Provider number.
API	Displays the Application Programming Interface (API) number.
NPI	Displays the National Provider Identifier (NPI) number
Locator	Displays the Provider locator number.
Taxonomy	Displays the Provider taxonomy number.
TaxID	Displays the Provider tax identification number.

Comments

The Comments section of the General tab displays any additional notes or information to be included about the Payer.

Plan Tab

The Plan tab displays the rate lines associated with a Payer, and their paper invoice setup. The Plan tab includes different rate line tabs such as Billing Rates and Payroll Rates.

Viewing Plan Closed

The Viewing Plan section of the Plan tab displays information about the currently viewed Payer plan and its associated settings.

Field	Description
Plan	Use this field to enter the name of the plan.
Printing	Use this dropdown to select the claim format for output.
Item Desc	Use this field to enter the line item description when invoicing.
Use Location Address on Invoice	Select this checkbox to use the location address when invoicing.
Active	Select this checkbox to indicate that the plan is active.
Default Event Code – Units	Use this dropdown to select the default event code for the Units.
Default Event Code – Hours	Use this dropdown to select the default event code for Hours.
Default Event Code - Visits	Use this dropdown to select the default event code for Visits.
Default Event Code - Absent Units	Use this dropdown to select the default event code for Absent Units.

Copay

The Copay section of the Plan tab displays copay settings for the Payer plan.

Field	Description
Copay Plan	Select this checkbox to indicate that this plan is a copay plan.
Has Copay	Select this checkbox to indicate that this plan has a copay.

Options - Plan Tab Closed

The Options section of the Plan tab displays additional invoicing options associated with the plan.

Field	Description
Show Balances	Select this checkbox to display account balances on invoices.
Under 21 Special Handling
Frequency	Use this dropdown to choose the length of the plan.
Term Offset	Use this field to choose the offset date amount for the plan.
Footer Text	Use this field to enter the text to be displayed on the bottom of the invoice.
Display confined text Locator 26 of 485	Select this checkbox to populate the Medicare confined test in locator 26 of the CMS 485.

Billing Rates Closed

The Billing Rates tab on the Plan tab displays the rates being billed to Clients or their insurer.

Field	Description
Service	Displays the service associated with the rate.
Event	Displays the event code associated with the rate.
Shift	Displays the shift code for the service associated with the rate.
PSC	Displays the place of service code associated with the rate.
TSC	Displays the time of service code associated with the rate.
RevCode	Displays the revenue code associated with the rate.
HCPCS	Displays the Healthcare Common Procedure Coding System code associated with the rate.
Misc	Displays any miscellaneous information about the rate.
Modifiers	Displays any modifiers associated with the rate.
Type	Displays how the service is calculated and billed.
Week Rate	Displays the rate if charged on a weekday.
Weekend Modifiers	Displays any weekend modifiers associated with the rate.
Weekend Rate	Displays the rate if charged on a weekend day.
Contract Type	Displays the contract type associated with the rate.
Contract Amount	Displays the contract amount associated with the rate.
Cap	Displays the cap amount associated with the rate.
Rank	Displays the rank of the rate.
Effective Date	Displays the date the rate began.
Alt Service Code	Displays the alternate service code associated with the rate.

Payroll Rates Closed

The Payroll Rates tab on the Plan tab displays the rates being paid to Field Staff for services.

Field	Description
Service	Displays the name of the service.
Event	Displays the event code associated with the service.
Shift	Displays the shift that the service occurs during.
Type	Displays how the service is calculated and paid.
Week Rate	Displays the weekday rate amount.
Weekend Rate	Displays the weekend rate amount.
Cap	Displays the cap amount associated with the rate.
Rank	Displays the rank of the rate.
Effective Date	Displays the alternate service code associated with the rate.

Add a New Rate Plan Closed

Payers can have a variety of different rate plans. For example, if providing billable services for Blue Cross/Blue Shield and it has multiple rate plans, billing rates can be set up for each plan separately and name them accordingly.

When adding a new Payor by default the name of the Plan will be Default, the invoice Printing type is Client Invoice.rpt and the Item Desc. Will be [Staff].

Go to the System Payor window under Main Menu > Billing > Payors.
Double click on the desired payer.
Select the associated Rate Plan tab.
Then, select the Add icon.
Select the appropriate settings and add the necessary rate information.
Select the Save button.

Edit an Existing Rate Plan Closed

Once a rate plan has been created, it can be edited any time.

Go to the System Payor window under Main Menu > Billing > Payors.
Double click on the desired Payer.
Select the associated Rate Plan tab.
Select the appropriate corrections or changes to the rates and settings.
Select the Save button.

Clone a Rate Plan Closed

Existing rate plans can be copied to the current or a different payer. To clone a rate plan:

Go to the System Payor window under Main Menu > Billing > Payors.
Double click the selected Payer.
Select the associated Rate Plan tab.
Select the Copy This Rate Plan button.
Select the Payer to copy the rate plan to.
Select the Save button.
Enter the new plan name.
Select the Ok button.

Deactivate an Existing Rate Plan Closed

If a rate plan is no longer in use but must be saved for whatever reason, it can become inactive rather than being deleted. To deactivate an existing rate plan:

Go to the System Payor window under Main Menu > Billing > Payors.
Double click the selected Payer.
Deselect the Active checkbox.
Select the Save button.

Remove an Existing Rate Plan Closed

A rate plan can be removed or deleted if it is not in use on any Client admission. To remove an out of date or incorrect rate plan:

Go to the System Payor window under Main Menu > Billing > Payors.
Double click the selected Payer.
Select the Delete this Rate Plan button.
Select the Yes button.

Filter Billing and Payroll Rates Closed

Users can search for rate line(s) by using the Service, Event Code, Type or Active filters. A current rate line becomes Inactive when a new rate line is created with the same Service/Event/Shift/Type/Rank combination and more recent effective date.

To filter the results, select the filters as desired and then select the refresh icon ().

Add a New Billing Rate, Payroll Rate, or Contract Number Closed

Once a rate plan has been created, it is ready to have new rates added.

Go to the System Payor window under Main Menu > Billing > Payors.
Double click the selected Payer.
Select the associated Rate Plan tab.
Select the tab of the rate to be added.
Select the Add icon.
Choose the service associated with the rate.
Enter the rate information.
Select the Save button.

Edit a Billing Rate, Payroll Rate, or Contract Number Closed

Once the rate has been added to an existing plan, it can be edited at any time.

Go to the System Payor window under Main Menu > Billing > Payors.
Double click the selected Payer.
Select the associated rate plan tab.
Select the tab of the rate to be edited.
Edit the rate information.
Select the Save button.

Clone a Billing Rate, Payroll Rate or Contract Number Closed

Once a rate has been created and updated, it can be cloned without having to re-add the rate information.

Go to the System Payor window Main Menu > Billing > Payors.
Double click the selected Payer.
Select the associated rate plan tab.
Select the tab of the rate to be cloned.
Right click the rate to be cloned and select the Clone button.
Select the effective date of the cloned rate.
Select Submit.

The cloned rate is displayed at the bottom of the rate list.

Delete a Billing Rate, Payroll Rate or Contract Number Closed

Existing rates that are no longer active, invalid, or expired can be deleted from the Payer plan.

Go to the System Payor window Main Menu > Billing > Payors.
Double click the selected Payer.
Select the associated rate plan tab.
Select the tab of the rate to be deleted.
Select the rate to be deleted.
Select the Delete icon.
Select the Yes button.

The selected rate is deleted.

Contacts Tab Closed

The Contacts tab displays the names, phone numbers, and addresses associated with a Payer.

Field	Description
Column one	Displays the type of contact.
Name	Displays the name of the contact.
Work Phone	Displays the work phone number of the contact.

Add a New Contact Closed

To add a new contact to a Payer:

Go to the System Payor window Main Menu > Billing > Payors.
Double click the selected Payer.
Select the Contacts tab.
Select the Add icon.
Enter the contact’s information.
Select the Save button.

Edit a Contact Closed

Once a contact has been added to a payer, it can be edited any time.

Go to the System Payor window Main Menu > Billing > Payors.
Double click the selected Payer.
Select the Contacts tab.
Double click on the contact to be edited.
Edit the contact’s information as needed.
Select the Save button.

Delete a Contact Closed

Contacts who have left the company or changed roles can be removed from a Payer at any time. To delete a contact:

Go to the System Payor window under Main Menu > Billing > Payors.
Double click the desired Payer.
Select the Contacts tab.
Double click the contact to be edited.
Select Delete.
Select the Yes button.

EDI Settings Tab Closed

The Electronic Data Interchange (EDI) Settings tab controls how the electronic billing for the Payer is formatted, configured, and sent.

When setting up a Payer that accepts electronic billing, the EDI Settings tab must be correctly configured to ensure billing exports to the Payer are in the proper format.

Changes to the EDI Settings can interfere with the acceptance of electronic claims. Be sure to work with an Implementation Specialist to properly set up and configure the EDI settings for the Payers. If there are additional issues, please reach out to Customer Care.

File Format and Options Closed

The File Format and Options section of the EDI Settings tab displays the electronic format and output settings associated with the Payer.

Field	Description
Format	Use this dropdown to select the claims format for the Payer.
Eligibility	This dropdown is used by Implementation to determine various eligibilities.
File Mask	Use this field to determine the layout of the claim file.
Max Claims	Use this field to set the number of claims that can be exported at once.
Max Lines	Use this field to set the number of lines than be exported per submitted claim at once.
Export No	Use this field to set the reference number for the claim submission.

Electronic Codes Closed

The Electronic Codes section of the EDI Settings tab displays the electronic code options for configuring exports and claim files.

Field	Description
EC ID	Use this field to select the type of Payer being billed.
EC Number	Use this field to enter the number of the Payer who is paying the claim.
Carrier Code	Use this field to enter the Payer’s carrier code.
Filing Ind	Use this field to enter the Payer’s filing indicator code.
Sender ID	Use this field to enter the sender identification code.
Sender No	Use this field to enter the sender identification number.
Receiver ID	Use this field to enter the receiver identification number.
Receiver No	Use this field to identify who receives the claim for processing.
Max Delay	This dropdown is used by Implementation to set the max delay number.
Default Code	This dropdown is used by Implementation to set the default code.

Misc. Options Closed

The Misc. Options area of the EDI Settings tab is used to configure a variety of options related to processing electronic claims.

Field	Description
GL Account No	Use this field to enter the agency’s general ledger number.
This Payer Uses a Supplemental File for 835 Pend/Deny Reporting	Select this checkbox if the payer uses a supplemental file to report Pending and Denied statuses on the claims.
Include Rendering Staff Name/NPI in 2420A Loop	Select this checkbox if the Payer requires the claim to include the rendering staff's name and NPI in the 2420A loop on the export file.
Include REF D9 line in EDI export.	Select this checkbox if the Payer requires that the REF D9 line be included in the export file.
Include Service Facility Address	Select this checkbox if the Payer requires that the service facility address be included in the export file.
Use Authorization Provider.	Select this checkbox to use the Authorization Provider.
Disable Export	Select this checkbox to disable the billing export for this Payer. When checked, the system does not create an export file for invoices attached to this payer.
Use 5010 when sending 270 files.	Select this checkbox if the Payer request that you send 270 files on the 5010 format. This enables the "270 Batch Eligible" field.
Remittance Format	Use this dropdown menu to choose the Payer's remittance format, 5010 or 4010.
Custom ID	Use this field to enter the custom identification number set by the agency.
Include Remit Address	Select this checkbox to include the Remit Address on the export file.
Use Carrier Codes	Select this checkbox to use carrier codes.
Include Ordering Physician in the 2420E Loop.	Select this checkbox if the payer requires the Order Physician information in the 2420E Loop on the export file.
Include Rendering Physician in the 2420A Loop.	Select this checkbox if the payer requires the Rending Physician in the 2420A Loop on the export file.
Report Supervising Staff Name and NPI	Select this checkbox if the Payer requires the Supervising Staff's name and NPI on the export file.
Include Contract Info in the 2310B Loop.	Select this checkbox if the Payer requires the contract info in the 2310B loop on the export file.
Include Contract Info in the 2310B Loop	Select this checkbox if the Payer requires the contract info in the 2310B loop on the export file.
Include G2 segment for 2310B Loop	Select this checkbox if the Payer requires the G2 segment on the 2310B loop on the export file.
Hold Visit Verification with no Address Type	Select this checkbox if you need the system to not auto-confirm visits for this Payer when there is no address type set on the client's profile.
Hold Visit Verification with no Zip Code	Select this checkbox if you need the system to not auto-confirm visits for this Payer when there is no Zip code set on the Client's profile.
Hold Visit Verification with no Service	Select this checkbox if you need the system to not auto-confirm visits for this Payer when there is no service verification on the visit.
Hold Visit Verification with no Customer Number	Select this checkbox if you need the system to not auto-confirm visits for this Payer when there is no customer number set on the Client's profile.

File Transfer Settings Closed

The File Transfer Settings area on the EDI Settings tab displays the connection information used to export claims.

Field	Description
Send To FTP Server When Generating File.	Select this checkbox to upload completed export files to the designated FTP server.
Secured FTP	Select this checkbox to add the information for the secured FTP server.
Server	Use this field to enter the IP address of the FTP server.
Port	Use this field to enter the port address of the FTP server.
Directory	Use this field to enter the default director to upload the exported claims to on the FTP server.
Login	Use this field to enter the login name for the FTP server.
Password	Use this field to enter the password for the FTP server.

Santrax Settings Tab Closed

The Santrax Settings tab controls how data is transferred between Sandata Electronic Visit Verification (EVV) and Sandata Agency Management.

Changes to the Santrax Settings tab can interfere with the transfer of data from Sandata Agency Maintenance to Sandata EVV. Be sure to work with Sandata Customer Support to properly set up and configure the Santrax Settings for your Payor.

Santrax Options Closed

The Santrax Options area of the Santrax Settings tab displays options for configuring a payer’s EVV settings.

Field	Description
Enable Santrax for Clients With This Payor	Select this checkbox to enable EVV for the Payer.
Santrax Account Number	Use this field to select the Payer’s Santrax Account Number. This field defaults to the Primary Santrax Account Number that was set by the Implementation Specialist. If the agency is set up for multiple Santrax Accounts, select the account number that is linked to this Payer.
Client Identifier	Use this dropdown to select the field that is used as the Client identifier for the Payer.
Contract Identifier	Use this dropdown to select the field that is used as the contract identifier for the Payer.
Payor Name	Use this field to specify the contract code if the contract identifier set to other.
A/R Identifier

Confirmation and Hold Settings Closed

The Confirmation and Hold Settings area on the Santrax Options tab contain options to limit the automatic confirmation of visits when calls are received, based on the number of required tasks completed and call duration.

Field	Description
Task required for confirmation	Select this checkbox to require tasks prior to changing a schedule's status to Confirmed.
Minimum number of tasks required	Select this checkbox and indicate the number of tasks required to change a schedule’s status to Confirmed.
Critical task required for confirmation	Select this checkbox to require Critical tasks prior to changing a schedule’s status to Confirmed.
Minimum number of critical tasks required	Select this checkbox and indicate the number of critical tasks required to change a schedule’s status to Confirmed.
Hold if Missing Task Reading	Select this checkbox to require a task reading to be entered prior to changing a schedule's status to Confirmed.
Include task in 3rd party export
Allowed Rounded Duration Differential	Use this field to specify at the Payor level how many minutes outside of the Proposed total hours a rounded Santrax hours value can confirm a visit, by setting the Allowed Rounding Duration Differential. If the visits actual rounded hours are outside the differential, the visit is marked as on hold. The default for this field is zero minutes.
Allowed Call Time Differential	Use this field to specify how many minutes outside of the proposed schedule the actual Santrax start time can be set to automatically Confirm the visit. If a visit call time is outside of the differential, the visit will be marked as on hold, and have the exception Call Time Outside Payor Tolerance. The default value for this field is 120 minutes.
Minutes from	Use this dropdown to set the threshold tolerance level.
Include Health Risk info in 3rd party Missed Visits export
Exclude schedules / visits with no auth from export files

Tasks Mapping Closed

The Tasks Mapping area of the Santrax Settings tab displays the exportable values of various tasks.

Field	Description
Task ID	Displays the task identification code.
Export Value	Use this field to enter the exportable value of the designated task identification code.

Telephony Exceptions Closed

The Telephony Exceptions area of the Santrax Settings tab displays the selected telephony exceptions that are enabled for use with Electronic Visit Verification (EVV).

Field	Description
Exception name	Displays the exception name.
Checked	Select this checkbox to enable the exception.
Exception code	Use this field to enter the exception code.
Send to AGG	Select this checkbox to export the flagged exception to Aggregator.

Program Codes Closed

The Program Codes area of the Santrax Settings tab displays the program codes associated with the established services.

Field	Description
Service	Displays the name of the service.
Program	Use this field to enter the program code for the associated service.

Add a New Program Code Closed

To add a new program code on the Santrax Settings tab:

Go to the System Payor window under Main Menu > Billing > Payor.
Double click the desired Payer.
Select the Santrax Settings tab.
Select the Add icon.
Use this fields to enter the service and program code.
Select the Save button.

Remove a Program Code Closed

To delete a program code from the Santrax Settings tab:

Go to the System Payor window under Main Menu > Billing > Payor.
Double click the desired Payer.
Select the Santrax Settings tab.
Select the program code to be deleted.
Select the Delete icon.

Providers Tab Closed

The Providers tab displays the provider numbers associated with the Payer.

Field	Description
Number	Use this field to enter the provider number associated with the Payer.
API	Use this field to enter the API number associated with the Payer.
NPI	Use this field to enter the NPI number associated with the Payer.
Locator	Use this field to enter the locator number associated with the Payer.
Taxonomy	Use this field to enter the taxonomy number associated with the Payer.
TaxID	Use this field to enter the tax identification number associated with the Payer.

Add a New Provider Closed

To add a new provider:

Go to the System Payor window under Main Menu > Billing > Payor.
Select the desired Payer.
Select the Providers tab.
Select the Add icon.
Enter the Provider numbers in the associated fields.
Select the Save button.

Remove a Provider Closed

To remove an existing provider:

Go to the System Payor window under Main Menu > Billing > Payor.
Select the desired Payer.
Select the Providers tab.
Then select the Provider to be removed.
Next, select the Delete icon.
Then select the Yes button.
The selected provider is removed from the Payer.

Staff Exclusions Tab Closed

The Staff Exclusions tab displays the list of all Field Staff marked for exclusion from employment associated with the Payer.

Field	Description
Staff Name	Displays the name of the excluded Staff Member.
Agency ID	Displays the agency identification number of the excluded Staff Member.
Exclusion Type	Displays the exclusion type of the excluded Staff Member.
Reason for Exclusion	Display’s the reason for excluding the Staff Member.
Start Date	Displays the beginning date of the exclusion.
End Date	Displays the ending date of the exclusion.

Add a New Staff Exclusion Closed

To add a new staff exclusion:

Go to the System Payor window under Main Menu > Billing > Payors.
Double click the desired Payer.
Then select the Staff Exclusions tab.
Select the Add icon.
Use the filters to locate the Staff Member and enter the exclusion reason information.
Select the Save button.

Remove a Staff Exclusion Closed

To remove an existing staff exclusion:

Go to the System Payor window under Main Menu > Billing > Payors.
Double click on the desired Payer.
Select the Staff Exclusions tab.
Double click on the staff exclusion to be removed.
Select the Delete icon.
Then select the Ok button.

Compliance Settings Tab Closed

The Compliance Settings tab displays the list of selected compliance items associated with the Payer.

Available Compliance Items Closed

The Available Compliance Items area of the Compliance Settings tab displays the list of compliance items that can be assigned to the Payer.

Field	Description
Name	Use this field to select the compliance item to be added to the Payer’s compliance settings.

Selected Compliance Items Closed

The Selected Compliance Items area of the Compliance Settings tab displays the list of compliance items that has been assigned to the Payer.

Field	Description
Name	Displays the name of the selected compliance item.
Description	Displays the description of the compliance item.
Result	Select this checkbox to require the result of the compliance item.
Cmp Date	Select this checkbox to require the completion date of the compliance item.
Exp Date	Select this checkbox to require the expiration date of the compliance item.

Add a New Compliance Item Closed

To add a new compliance item to a Payer:

Go to the System Payor window under Main Menu > Billing > Payors.
Double click the desired Payer.
Select the Compliance Settings tab.
Then select the compliance item to be added.

More than one item can be selected by pressing Ctrl and selecting the additional items.
Select the arrow head button to add a compliance item.
Enter the compliance item information in the fields.
Then select the Save button.

Remove a Compliance Item Closed

To remove a compliance item:

Go to the System Payor window under Main Menu > Billing > Payors.
Double click the desired Payer.
Select the Compliance Settings tab.
Select the compliance item to be removed.

More than one item can be selected by pressing Ctrl and selecting the additional items.
Select the arrow head button to remove a compliance item.
Then select the Save button.