Professional Edit Maintenance by Payer

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There will be occasions when edits for a particular payer need to be configured differently than other payers within a particular claim type. Use the Professional Edit Maintenance by Payer page to make these individual payer configurations.

REMINDER: Working payers must first be set up via the Payer Maintenance page in order to be available for modification.

Accessing the Professional Edit Maintenance by Payer page

The Professional Edit Maintenance by Payer page is accessible only from the Professional Edit Maintenance by Claim Type page. To view the page, select the link for the desired claim type in the column header as shown in the example below.

Screenshot of the seven claim type columns in the Professional Edit Maintenance table on the Professional Edit Maintenance by Payer page. The Commercial column header has a link, which is being selected.

You are presented with the Professional Edit Maintenance by Payer page.

Configuring a payer's edits

To make changes to a payer's edit configuration, select the payer from the list of payers at the top of the page.

Screenshot of the Working Payer list. The payer, ABC HEALTH PLAN, is being selected.

The edit configuration for the selected payer will be displayed in the Edits portion of the page. There are two ways to make changes to this edit configuration.

  1. Enable or disable individual edits for the payer – Under the appropriate payer's column, check or uncheck the individual check box in the row for the desired edit.

    Screenshot of a check box under the ABC Health Plan column being selected.

  2. Enable or disable all edits for the payer – Selecting the check box above a payer's name in the column header will enable (check) or disable (uncheck) all edits for that payer.

    Screenshot of the ABC Health Plan column. The check box above the column header is selected. All the check boxes under the column are now checked/enabled.

Select Apply when done making changes. A message displays indicating the edits were successfully updated.

Select Cancel to return to the Professional Edit Maintenance by Claim Type page.

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