Billing lives or dies on setup. Payers holds how each payer wants claims, how you check eligibility, and what it pays. Financial Codes is the code library behind claims and remittances. Both live in Settings under Agency Management.
Set up a payer
Open Settings → Payers. Click Add Payer — a payer named New Payer is created.
Open it and work the tabs:
Tab | What to complete |
Basic Info | Payer name, payer ID, payer type; contacts; contract dates and network status; addresses |
Billing Rules | Billing Type, Claim Form Type, Billing Frequency, payer-specific notes such as NOA notes — billing screens read these, so an error here surfaces later as a claim problem |
Eligibility & Auth | Where to verify eligibility (website, phone, payer ID) and how to request authorizations (timing, website, phone, fax) |
Fee Schedule | Add Item per service line — reports and billing use these rates |
Aliases | Every alternate spelling of the payer's name, so incoming documents match automatically |
Documents | Contracts and reference documents |
Warning: Changes are held until you save. A bar at the bottom reads "You have unsaved changes" with Undo and a save button. Navigating away without saving loses the edits.
The toggle on each payer row activates or deactivates it.
Manage financial codes
Open Settings → Financial Codes. Codes are grouped into four tabs: Eligibility, Claim Codes, Service Codes / Fee Schedule, and Remittance & Adjustments.
Toggle a code on or off for your agency — inactive codes stop appearing in pickers. Standardized categories are read-only.
Where a category allows agency-defined entries, use the add action and complete Add custom code.
Note: Standard code sets are maintained centrally and updated when CMS updates them. You never load CMS code lists yourself.
If something goes wrong
A claim came out wrong for one payer. Start on that payer's Billing Rules tab — claim form type and billing frequency drive claim preparation. Then check the Fee Schedule for the service.
Incoming referrals attach to the wrong payer, or none. Open the intended payer's Aliases tab and add the exact spelling that appears on the documents.
A code cannot be edited. Standardized categories are read-only by design; you control only whether a code is active.