PayerMasterfi
The table contains information about payer records.
| Column Name | Type | Description |
|---|---|---|
| AlternateClaimPhoneNumber | VARCHAR | Stores alternate address phone number |
| PayerZipCode | VARCHAR | The ZIP Code in which the payor is located. |
| PayerReportGrouperEighteen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and fifteen category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the eighteenth category report grouper. |
| PayerReportGrouperTwo | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the second free text report grouper. |
| PayerBillingDiagnosisRelatedGroup | INTEGER | The category number representing the reference date used to determine the Billing DRG Type for the payor. |
| PayerPhoneNumber | VARCHAR | The phone number for the payor. |
| PayerProducesPartBInpatientClaimsIndicator | VARCHAR | Indicates whether inpatient claims should be Part B claims for this payor. |
| PayerReportingGrouperCategorySixteen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and fifteen category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the sixteenth category report grouper. |
| IncludeBadDebtInNonDemandClaimsFlag | VARCHAR | Flag to allow the inclusion of bad debt charges on non-demand claims. Will only affect PB claims processing. |
| PayorDuplicateCoveragePreventionLevel | INTEGER | Level at which the payor's plans without a plan-level override will warn or stop the user from creating a coverage with the same payor/plan combination as another coverage on the applicable guarantor or hospital account. The setting only applies if nothing is set at the plan level. If nothing is set in either payor or plan, then the guarantor's Service Area's setting will be used. The default is 0-No Prevention. |
| ShouldPrintAnesthesia | VARCHAR | Indicates whether anesthesia timed procedures should be printed on claims in terms of units for this payor. |
| IsPayerContractedIndicator | VARCHAR | This column indicates whether or not the payor is contracted. This is for informational purposes only. It does not drive contracts or billing reports. |
| SupportsPartialPrescriptionFillsIndicator | VARCHAR | Indicate whether this payor supports partial prescription fills. This setting can be overridden at the plan level. |
| SaveFullGrouperPlusResponseIndicator | VARCHAR | This is a flag so that users can choose whether to save the full detailed APC Grouper Plus responses in the CLP when data is loaded. |
| CaseInsuranceWriteOffProcedureIdentifier | NUMERIC | The insurance write-off procedure used to write off case charges to zero balance in case rate insurance payment posting. |
| PhysicalDeploymentOwnerIdentifier | VARCHAR | ID of the physical deployment owner for this record. Physical owners will be where the data is hosted, either on the cross-over server or the owner deployment. |
| PayerReportingGrouperTwelveCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and fifteen category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the twelfth category report grouper. |
| PayerName | VARCHAR | The name of the payor. |
| PrescriptionAdjudicationPayorSheetExtensionIdentifier | NUMERIC | Extension to select what payor sheet to use during Rx adjudication. If the extension does not return a value, the transaction table will be used to find the payor sheet. The plan level payor sheet extension is always checked first, then the plan level table, then the payor level payor sheet extension, and then the payor level table. |
| RyanWhiteMedicalInsuranceCategory | INTEGER | This is the category value for the Ryan White insurance type. This defines the insurance type of this payer as required by the Ryan White Services program for reporting. |
| ClaimFilingDeadlineDays | NUMERIC | If this Payor has set a limit on the number of days from the date of service by which claims must be filed, enter the number of days allowed here. Entering a number here will not prevent late claims from being submitted, but it will allow the application to determine when Payor-specific exception codes should be sent and adds the flexibility to define edit checks that will place late claims into an error run during claims processing. The number entered here can be overridden for specific plans by entering a different value in the Benefit Plan master file. |
| LogicalDeploymentOwnerIdentifier | VARCHAR | ID of the logical deployment owner for this record. Logical owners show the deployment where the record was created but doesn't represent if the record is a part of version skew. |
| PayerPartDRxGroupIdentifier | VARCHAR | This column stores the plan's group identifier for its members. |
| ExcludeModifiersGeneratedAuthorizationIndicator | VARCHAR | Indicates whether modifiers are prevented from being populated when service-level authorizations are automatically created for this payer. |
| PayerReportGrouperTenCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the fifth category report grouper. |
| DefaultClaimGroupingPointerIdentifier | NUMERIC | The unique ID of the default claim grouping pointer for this payor. |
| AlternateClaimAddressCity | VARCHAR | The city for the alternate claim address. |
| PayerShortName | VARCHAR | The short name of the payor. |
| MedicareAdvantageContractNumber | VARCHAR | This column contains the Medicare Advantage contract number, which identifies the benefit plan represented by this payor record to CMS. |
| PayerReportGrouperNineteen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and fifteen category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the nineteenth category report grouper. |
| PayerReportGrouperFour | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the fourth free text report grouper. |
| PlanTierType | NUMERIC | This field identifies if this payor's plans are two-tier plans, three-tier plans or they have no tier information. |
| ReferencePayerFinancialClass | INTEGER | Holds the reference payer-financial class used for mapping and benchmarking. The value here is calculated based on the payer's reference payer and reference financial class rather than being set directly. |
| ShowAnesthesiaPhysicalStatusModifierIndicator | VARCHAR | Indicates whether physical status ("P") modifiers will be shown on anesthesia claims. |
| CheckCrossoverRemittanceExceptionIndicator | VARCHAR | Flag to allow checking the payor level crossover exceptions, even if the information in the remit file is respected and it says a crossover claim has been sent. |
| IsExplanationOfBenefitsDrivenPaymentPostingEnabled | VARCHAR | Indicates whether EOB-driven insurance payment posting should be enabled for this Payor. |
| PayerReportGrouperFive | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the fifth free text report grouper. |
| PayorCity | VARCHAR | The city in which the payor is located. |
| IncludeZeroBalanceOnDemandClaimIndicator | VARCHAR | Indicates whether charges with an insurance balance of zero should be included on a demand claim to this payor. |
| ShowAnesthesiaSocietyCodeOnClaimIndicator | VARCHAR | Indicates whether the ASA code will be shown on anesthesia claims. |
| RecombineBucketsIfPayor | VARCHAR | Indicates whether previously split buckets should be recombined when the payor is secondary. |
| PayerAmbulatoryPaymentClassificationGrouperDisplayProgrammingPointIdentifier | NUMERIC | This item holds the programming point that displays an alternate view of the APC Grouper messages for a claim. |
| PayerProcessorControlNumber | VARCHAR | The Processor Control Number (PCN) used during prescription adjudication. This can be overridden at the plan level but if nothing is specified at the plan level, the payor level PCNs are used. |
| PayerReportGrouperElevenCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and fifteen category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the eleventh category report grouper. |
| PayerIsSuperPayerIndicator | VARCHAR | Determines if payer record is a generic super payor record |
| AlternateClaimAddressCountry | VARCHAR | Stores the alternate claim address country. |
| PayerRecordState | INTEGER | The record state of the remittance code record (e.g. inactive, deleted, etc.). |
| NonPrimaryBankInformationNumber | VARCHAR | The Bank Information Number (BIN) used during prescription adjudication for non primary coverages. Leave this field blank if the same BIN is used regardless of whether the coverage is primary or secondary. If no non-primary BIN is specified, the BIN will be used for non-primary coverages. This can be overridden at the plan level, but if nothing is specified at the plan level, then the payor level BINs are used. |
| PatientFriendlyPayerName | VARCHAR | Contains a name for this payor that can be displayed to patients when viewing insurance or choosing new insurance to register. |
| ReferenceFinancialClassIdentifier | INTEGER | Holds the reference financial class used for mapping and benchmarking. |
| PayerClaimMailingAddressCode | INTEGER | This item contains the default mail code, i.e. where claims are sent, for coverages created with this payor. This is overridden by the default mail code specified at the benefit plan level. 1-Send Claim to Payor 2-Send Claim to Account 3-Send Claim to Payor Plan |
| IncludeWasteInPrescriptionComponentDispenseQuantityIndicator | VARCHAR | Determines whether prescription-coverage-adjudicated claims will include waste in the component dispense quantity |
| AlternateClaimStateCategory | VARCHAR | The state category number for the alternate claim address. |
| UsePlanNameOnClaimsOptionIndicator | VARCHAR | If the CLAIM_MAIL_CODE_C is set to 3-Send Claim to Payor Plan, it can be specified here that the name of every plan associated with this payor should be used on claims. Otherwise the payor name is used. |
| PayerReportGrouperCategoryThirteen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and fifteen category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the thirteenth category report grouper. |
| PayerPreauthorizationPhoneNumber | VARCHAR | The phone number for the authorization contact at this payor. |
| AlwaysWriteOffPayerNotAllowedAmountIndicator | VARCHAR | Determines whether the system should always post the payor-specified not-allowed amount when using the Write Off Payor Amount option and ignore any existing payments and NAA in the liability bucket. |
| PayerDefault | VARCHAR | This column contains the default reimbursement source for claims processed for this payor. |
| PayerDenialAppealWindowDays | INTEGER | The number of days a payor allows for appeal of denials or underpayments. |
| SendZeroDollarPrescriptionClaimIndicator | VARCHAR | If this item is set to Yes, when a prescription charge is adjudicated in Willow Ambulatory for a non-primary coverage using this payor, and previous coverages in the filing order have paid the full amount, the system sends a zero-dollar claim to this payor. Some payors require zero-dollar claims for compliance purposes. If this item is blank or set to No, the system doesn't send zero-dollar claims in the scenario described above. This setting can be overridden at the plan level (I EPP 12026). |
| PayerSoftwareVendorIdentifier | VARCHAR | The software vendor ID given by the payor for prescription adjudication. |
| AllowPharmacyTestBillingIndicator | VARCHAR | Some payors do not allow the pharmacy to test billing without a valid prescription having been entered into the system. This setting controls whether test billing is allowed for the payor within ambulatory pharmacy. This setting also applies to the Test Billing activity used for benefits investigation during patient enrollment into Home Infusion and Speciality Pharmacy programs. |
| SingleComponentLastPrescriptionPayerId | NUMERIC | This extension will return a single component for a single component prescription-coverage-adjudicated claim. All subsequent payers will respect the setting at the primary payer level. |
| PayerUdsCoverageClassCategory | INTEGER | The category number for the UDS coverage class. This defines a coverage as medical, dental, etc. for the purposes of UDS reporting. |
| PayerPaymentTypologyCode | INTEGER | This item is being created to store typology codes. |
| PayerFinancialClass | VARCHAR | The category value associated with the payor’s financial class. |
| PayerReportGroupSixCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the first category report grouper. |
| PayerReportGrouperFourteen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and fifteen category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the fourteenth category report grouper. |
| PayerReportGrouperCategorySeven | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the second category report grouper. |
| AlternateClaimAddressZipCode | VARCHAR | The ZIP code for the alternate claim address. |
| SingleComponentClaimRuleIdentifier | VARCHAR | This rule will be evaluated during a prescription-coverage-adjudicated claim. If it returns true, then the claim will be a single component claim. All subsequent payers will respect the setting at the primary payer level. |
| PayerProductTypeCategory | VARCHAR | The product type category number for the payor record. |
| PayerNeverNeedsAuthorization | VARCHAR | Flag that indicates that a payer never needs authorization |
| PayerEnabledForElectronicVerificationFlag | VARCHAR | Flag to control if the payor is enabled for electronic verification. |
| PayerInterimBillCycleDays | NUMERIC | When processing interim bills in the background, this value will determine the number of days between interim bills. |
| PayorIdentifier | NUMERIC | The unique identifier (.1 item) for the payor record. |
| ReportGrouperFreeTextOne | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the first free text report grouper. |
| PayerFaxNumber | VARCHAR | The fax number for the payor. |
| PayorBilling | INTEGER | Payor's billing municipality |
| PayorSourceType | VARCHAR | This column indicates whether the payor is an internal or external payor. Internal may be used to handle the special situation where you have a program that acts as a payor within your facility, but this program only pays after all external payors have paid as if they were the sole payors. The internal payor will not show up as an Other Payor in CMS Box 9, UB FL 50, the DA0 segment of NSF electronic claims, or in loop L2330B for ANSI electronic claims. Setting this field to Internal will set this payor's File Claim field to Never. |
| DefaultDiagnosisRelatedGroupTypeId | NUMERIC | The default DRG Type (MPI ID) used for billing by the payor. |
| ZeroInsuranceBalanceClaimSubmissionComponentGroupIdentifier | VARCHAR | The Component Group ID to allow zero dollar Insurance Balance Claims to be submitted. |
| RepricedPaperUniformBillForm | VARCHAR | Indicates the manage care system Repriced Paper UB form to submit to the payor. |
| AnsiSecondaryClaimAdjustmentCode | VARCHAR | Adjustment code for ANSI secondary claims |
| IntraConnectPhysicalOwnerCommunityIdentification | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| PayerReportGrouperEightCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the third category report grouper. |
| PayerReportingGrouperNine | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the fourth category report grouper. |
| PlanBenefitPackageNumber | VARCHAR | This column contains the unique identification number for the Plan Benefit Package, which is a set of benefits for a defined Medicare Advantage or prescription drug plan service area. |
| DefaultRefundDebitAdjustmentIdentifier | NUMERIC | The unique ID of the default refund debit adjustment code. |
| PayerReportGrouperFifteen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and fifteen category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the fifteenth category report grouper. |
| PayerReportGrouperThree | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and five category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the third free text report grouper. |
| PayerNonPrimaryCoverageProcessorControlNumber | VARCHAR | The Processor Control Number (PCN) used during prescription adjudication for non-primary coverages. Leave this field blank if the same PCN is used regardless of whether the coverage is primary or secondary. If no non-primary PCN is specified, the PCN will be used for non-primary coverages. This can be overridden at the plan level, but if nothing is specified at the plan level, then the payor level PCNs are used. |
| ResubmitZeroInsuranceBalanceClaimIndicator | VARCHAR | Indicates whether charges with an insurance balance of zero should be included on a resubmitted claim to this payor. |
| PayerReportingGrouperSeventeen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are five free text groupers and fifteen category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is the seventh category report grouper. |
| PayerAddressLineOne | VARCHAR | The first line of the payor's street address. |
| IsManagedPayorFlag | VARCHAR | A flag that indicates if this is a managed payor. |