Creating Policies
Payer policies tell SpokeChoice who is going to be paying for a client. Currently they can be either DDD, Insurance or Private. You must indicate to the system what payer will be funding the services.
To do so follow these steps.
Navigate to Homecare-health plans
Select the member for whom you wish to enter a payer policy
Select the type of payer.
Note: If you are selecting DDD you only have to enter their medicaid ID and their Assist ID. If you are entering a policy for insurance you need all the applicable information that is outlined in red.
Once you are finished hit the save all button and this client now has a payer policy. If you wish to change this policy and open a new one you must close it. Keep in mind if you have a payer that is still paying you, never delete a policy rather close it so you can continue to bill against it or receive any outstanding payments
If you want to user a private payer you must first set them up as a payer. For example if you have a client who's name is Jimmy Johnson you'll want to go over to Backoffice-payers and add a new payer called JohnsonFamily or something that you remember. Fill out all the information on the payer. After this complete you can go back to client payers and you should see the JohnsonFamily as a payer. You will also need to add service codes along with a billing code that is for "private payer". Add in the amount you want to charge the member/family for each service.
Private payer
If you want to user a private payer you must first set them up as a payer. For example if you have a client who's name is Jimmy Johnson you'll want to go over to Backoffice-payers and add a new payer called JohnsonFamily or something that you remember. Fill out all the information on the payer. After this complete you can go back to client payers and you should see the JohnsonFamily as a payer. You will also need to add service codes along with a billing code that is for "private payer". Add in the amount you want to charge the member/family for each service.
Routing
Payers are routed by the system automatically. What this means is that if you have two payers, insurance and then DDD, by putting them in the proper order the system will route to the primary (1st) and then to the secondary (2nd) after an EOB or payment has been received. If you later find that a payer is terminated you need to end all policies on the date the payer will no longer be eligible to bill and start the single payer on the next day. By doing this the past claims can be routed to payer 1 and payer 2 and any subsequent payers (in this example the single payer) would be routed.