Institutional 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 Institutional 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 Institutional Edit Maintenance by Payer page

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

Screenshot of the Institutional Edit Maintenance table with seven claim type columns and three rows of check boxes. The Commercial column header has a link, which is being selected.

You are presented with the Institutional 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 working payers.

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

The edit configurations for the selected payers will be displayed in the Edits portion of the page. There are two ways to make changes to these edit configurations.

  1. Enable or disable individual edits for the payer – Under the appropriate payer's column, check (enable) or uncheck (disable) individual check boxes in the row for each applicable 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 the Apply button when complete to save your changes. A message displays indicating the edits were successfully updated.

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

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