Chapter 6: Payer Setup
Chapter Overview
What You'll Learn:
- How to open Payer Setup
- Adding payers from the Betasky catalog vs Self Pay / Custom
- Enrollment, clearinghouse (Stedi), and rates tabs (HIPPS / Fee Schedule / Service Codes)
- Deactivate / reactivate
- Billing-only differences
Time to Complete: 20–25 minutes
Who Should Read This: Agency Administrators, Billers who configure payers
Prerequisites: Chapter 4
Text-only. Labels match the screen.
6.1 How to Open Payer Setup
| Agency type | Path |
|---|---|
| Full EMR | Sidebar Setup → Payer Setup, or Settings → Payer Setup |
| Billing-only | Sidebar Setup → Payer Setup → /dashboard/payer-setup |
Permission: manage payers.
6.2 What You See on the List
Full EMR sections often include:
- Betasky catalog payers
- Self pay & custom
- Optional Retired (legacy) with Show N retired payer(s)… / Hide retired payers
Buttons:
- Add from Catalog — primary path for Medicaid/ODM, MCOs, Medicare, commercial catalog payers
- Add Self Pay / Custom — full EMR only (hidden for billing-only)
Columns: Payer name · Payer type · Claim billing mode · Electronic payer ID · Status · Actions
Chips you may see: Catalog, Use catalog ODM, Catalog inactive.
6.3 Add from Catalog
- Click Add from Catalog.
- Modal: Add Payer from Catalog.
- Choose Payer, set Contract start / Contract end, optional Provider NPI.
- Click Enroll Payer.
Catalog payers are platform-managed for many profile/rate fields. Agencies mainly manage enrollment, contract dates, provider IDs, and clearinghouse steps.
6.4 Add Self Pay / Custom (full EMR)
Use Add Self Pay / Custom when the payer is not in the catalog (or for self-pay).
Billing-only agencies cannot add custom/self-pay from this UI — catalog (unit-based) only.
6.5 Payer Detail Tabs
Open a payer. Tabs depend on type and claim billing mode:
| Tab | When |
|---|---|
| Enrollment | Catalog / platform-managed payers |
| Profile & Rules | Custom payers |
| HIPPS Rates | Mode MEDICARE_PDGM |
| Service Codes | Mode UNIT_BASED (Medicaid/ODM/many MCOs) |
| Fee Schedule | Per-visit style modes |
Enrollment (typical fields)
- Contract start / end
- Provider NPI (optional)
- Medicaid Provider ID
- 835 ERA (Stedi) status display
- Section Clearinghouse Enrollments
Clearinghouse enrollment (Stedi)
- Enroll Transaction Type (or equivalent CTA on the Enrollment section).
- Modal Enroll Payer with Clearinghouse:
- Select Transaction Type
- Contact Email *
- Aggregation Preference *
- Requested Effective Date
- Start Enrollment
Transaction type labels include:
- 835 ERA (Claim Payments)
- 837P (Professional Claims)
- 837I (Institutional Claims)
- 270/271 (Eligibility Checks)
- 276/277 (Claim Status)
Follow Action Required / Submit & continue tasks until enrollment completes. Ohio Medicaid ID helpers may mention a 7-digit provider ID.
Rates tabs
- Platform-managed catalog payers may show rates as read-only (“managed by Betasky”).
- Custom payers can Add Rate on Fee Schedule / maintain service-code rates when editable.
- Details for rate grids: Chapter 12: Fee Schedule Setup.
6.6 ODM / Unit-Based Notes
- Many Ohio Medicaid / MCO catalog payers use UNIT_BASED claim billing mode → Service Codes tab.
- Chip Use catalog ODM warns against inventing a duplicate custom Medicaid when catalog ODM exists.
- Scheduling and New Claim use service codes + hours/units for these payers.
- Billing-only catalogs are filtered to unit-based catalog payers (explained in the Add from Catalog modal — not only as a list-page alert).
- Full EMR: enrolling / creating / updating payers typically requires agency CCN (billing-only is exempt).
6.7 Deactivate / Reactivate / Delete
From list or detail actions:
- Deactivate Payer — stops new billing against that payer (may remap guidance for ODM/unit-based)
- Reactivate Payer → dialog Reactivate Payer? (contract start/end)
- Delete Payer — available when the product allows hard delete for that payer type
Prefer deactivate over delete when historical claims exist.
6.8 Billing-Only Differences
| Topic | Billing-only |
|---|---|
| Path | /dashboard/payer-setup (not under Settings) |
| Add Self Pay / Custom | Hidden |
| Catalog | Unit-based catalog payers |
| Legacy remapping panel | Not shown |
6.9 What Not to Expect (outdated ideas)
- A simple “Medicare / Medicaid / Private” create form as the only path — catalog enrollment is primary
- Freely editing all HIPPS/rates on every catalog payer
- Co-pay / deductible / max-visit “billing rules” blocks that are not in the current UI
- Fee schedules living on branches — they live on the payer
6.10 Quick Checklist
- Catalog payers enrolled with contract dates
- Stedi transaction types started where you submit electronically
- Correct rates tab visible for the payer’s claim billing mode
- Billing-only: only unit-based catalog payers configured