Vocabulary

Primary—the payer who is billed first

Secondary—the payer who is billed second

Tertiary—the payer who is billed third

Quaternary—the payer who is billed fourth

Quinary—the payer who is billed fifth

Remainder Payer—the payer who receives the remainder (whatever is left over) after all other payers have been assigned their portion of the bill

Per Diem Allowance—an amount per calendar day that a payer is willing to pay

Difference—a percentage or dollar amount of the total invoice that a payer is willing to pay

Visit-- an amount per visit that a payer is willing to pay

Weekly--an amount per week that a payer is willing to pay

Monthly-- an amount per calendar month that a payer is willing to pay

Client Authorization-- an amount per day/week/month/year that is pre-approved by the payer and should not be exceeded in scheduling


Process

Go to Client>Payers and add the new payer (or confirm that the payer is already in the portal)

Once you have confirmed that the Payer is in your portal, navigate to the Rates tab of the client profile and select + Existing Payer

Start typing the payer’s name in the Company field, select the correct one from the options, and then choose search

Choose select to open the Client Payer configuration window

When the Add Client Payer page opens

  1. Select Primary as the Rank

  2. Enter the Member ID #

  3. Select Client Authorization as the Payment Distribution

4. When the window opens, enter the information for the authorization and save

5. If there is another authorization for the SAME payer, you can add it by clicking by the +Authorization button

If you will be submitting your EVV data to Sandata, you will need to add information for the Parent Payer Program as well.

In Ohio, if Passport is the waiver program, you'll also need to know and enter the PMSID number.

When all the authorizations have been added, select the correct Claim File Indicator Code, and change the Billing Type if you don't bill weekly, then click Update

NOTE: You must always have 1 payer set to the be the “Remainder” payer. By default, that will be the client, but you can always make the last payer in the list of multiple payers the remainder.

For help with other Billing Configurations, see these articles:

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