Creating an Eligibility Payor ID Override

The payor ID used to verify eligibility may differ from the payor ID that is used on claims. If there is no payor ID override created for a payor, the software will use the claims Payor ID (as listed in Master Files | Payors / Plans | Payors) by default. To ensure eligibility submissions are not rejected, set up the correct payor ID.

To create an override to account for the eligibility payor ID, follow the steps outlined below:

1.    Navigate to Master Files | Payors/Plans.

2.    From the Payors grid, select the appropriate payor and then click the Plans tab.

3.    Select the applicable plan from the grid and then click the Eligibility tab. Existing overrides for the selected payor/plan will in the File Transaction Overrides grid.

4.    If necessary, click    to begin a new override record.

5.    In the Loop drop-down field, select Loop 2100A – Information Source Name.

6.    In the Segment drop-down field, select NM1 – Information Source Name.

7.    In the Element drop-down field, select NM109 – ID Code.

8.    In the Override field, type in the eligibility payor ID for the payor/plan.

9.    Click    to save the new override record.