Payor Code Mapping - Add New Payor Code

Note: See Payor Code Mapping for additional information.

Procedure

From the Payor Code Mapping page, use the following to add a new payor code:

  1. Click the plus icon to begin and make the necessary changes to the defaulted information.

  1. You can also add new payor code when an existing match is not found.

Note: The side bar is disabled while your are in the add mode.

  1. With the new row, the following fields are populated with default information:

    • Payor Code - enter a single payor or enter multiple payor codes separated with a comma. Multiple payor codes must use the same criteria. If one or more payor codes is already mapped, any conflicts display as a duplicate with an error message at the top of the page.

    • Facility - includes a drop down list of available facilities.

    • Contract Profile - includes a drop down list of contract profiles for the facility.

    • Product Name - includes a drop down list of the product names for the facility.

    • Active - includes a drop down of Y (Yes) or N (No). Default is set to Yes.

    • Patient Type - includes a drop down list of blank (default), Inpatient, Outpatient, or Professional.

    • Transaction Code fields default to 9999.

    • Exclude Non-Billable - - includes a drop down of Y (Yes) or N (No). Default is set to N. If the facility does not use Exclude Non-Billable, the column displays N/A.

Note: Enter Date, Entered Time, and Saved By fields cannot be edited when adding a new payor code.

  1. The following are required fields and are indicated with a red asterisk (*)

    • Contract Profile

    • Product Name

    • Rank (numeric value)

Note: Generally you set Rank to 1, but there are occasions where the same payor code is mapped to multiple products. This requires a unique identifier such as NPI or Taxonomy, etc. and the more specific mappings are given a raking 1, followed by 2, 3, etc. with the less specific or default mapping as the higher Rank number.

  1. You are presented with an error message when Product Name and/or Rank are blank. Make the appropriate corrections to proceed.

  1. Text fields do not allow special characters ('\!@#$%^&*+={}[]|:;?`~). You are presented with an error message if a special character is entered. Make the appropriate corrections to proceed.

  1. Click Save to record the new payor code mapping. With this action, the system validates that the payor code effective/term dates do not overlap an existing payor code and is truly unique.

Note: The Save button does not appear on the page until all required fields are populated.

  1. (Optional) Click Cancel anytime (prior to clicking Save) so that the current entry is not saved.

  1. After selecting Cancel, you are prompted with the following message. Make the appropriate selection.