1. What are the benefits of PayorID.com?

  2. We have access to the patient's ID card and the telephone directory, so why should we subscribe to PayorID.com? 

  3. Managed care organizations provide us with client/payor updates, so why should we subscribe to PayorID.com?

  4. Our organization contracts with many MCOs, so why should we subscribe to PayorID.com?

  5. Our organization does not contract with many MCOs, so why should we subscribe to PayorID.com?

  6. Why do we want claims information on payors we do not have a contract with? 

  7. How will PayorID.com  relate to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Plan Identifier?

  8. How much does a PayorID.com subscription cost?

  9. Does the PayorID.com application replace our existing claims registration system?

  10. Can we do patient eligibility verification and claims status verification on-line?

  11. Can PayorID.com help with returned mail claims?

  12. Can additional employer information be added to PayorID.com?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 What are the benefits of PayorID.com?

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PayorID.com can save your organization time and money!

Keeping up-to-date claims processing information is a full time job.  MHIS Information Specialists consolidate information on payors into one source.  Most providers do not devote enough staff to manage this information.  A provider with twenty-five contracts could devote one staff person dedicated to this function alone.

The claims, eligibility verification, and utilization management phone numbers as well as electronic billing codes are always available in PayorID.com.   MHIS maintains files that cross-reference employers health and workers compensation plans.  When a user does not find  information on a payor in the PayorID.com system, they can notify an MHIS Information Specialists via email.  MHIS will perform the necessary research to gather the appropriate data and add the new information into the PayorID.com system.  An email response to the user will also be sent.

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We have access to the patient's ID card and the telephone directory, so why should we subscribe to PayorID.com?

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Patients do not always carry their ID cards and when and ID card is presented the information listed is often incorrect. The telephone directory lists the physical addresses as apposed to the claims office addresses.   Patient ID cards and telephone directories will not include electronic billing codes or links to the payors web sites.

Many payors do business under various marketing names, AKA (also-known-as) names, or have changed names following a merger or consolidation.  The telephone directory does not have these alternative references.  The local telephone directory does not include the numbers for the out-of-state payors.  Patients may present an old ID card with out of date information.

Many payors become affiliated with more than one contracting network, or use third party administrators to process claims, or use utilization management organizations to authorize services.  This information is not available in the phone directory or on the patient's ID card.

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Managed care organizations provide us with client/payor updates, so why should we subscribe to PayorID.com?

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Organizations usually contract with dozens of managed care organizations (MCOs).  Most MCOs contract with hundreds, if not thousands, of payors, employers, medical groups, and other organizations.  Due to the number of relationships within and between MCOs, it is beneficial to use a single source that cross-references the participants of all the managed care organizations.

PayorID.com simplifies and reduces the cost of maintaining a file on all managed care participating payors, agents, third party administrators, and medical groups.  PayorID.com also maintains all the prior names of organizations, and links indicating the relationships between old and new names.

There is no standardization of the client/payor lists provided by the MCOs.  Each individual client/payor listing published is printed in a unique format.  Many do not list all claims offices and most do not provide electronic billing codes.

Many payors do business under various marketing names. Frequently those alternative names are not available in the client/payor listings.  Payors often become affiliated with one or more contracting networks, or use third party administrators for claims or utilization management. Therefore, it would be necessary to reference multiple payor listings.  Often this type of information is not cross-referenced in the client/payor list.

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Our organization contracts with many MCOs, so why should we subscribe to PayorID.com?

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The vast majority of patients are now enrolled in some form of managed care.  MHIS specializes in collecting and organizing the key administrative information on MCO's payors.

Maintaining unique contract terms and conditions requires a significant amount of staff time.  Every MCO is different and each contract has unique payment terms and conditions.  Organization's internal insurance master file needs to be maintained to assure that all contract terms and conditions are followed.

Contact information, claims offices, utilization management and patient eligibility phone numbers, and participating payors in an MCO apply to every provider contract.  MHIS can relieve your staff from maintaining this information on a MCO.

MHIS Information Specialists know the names of payors that participate with contracting networks, and payors that participate in multiple networks, as well as the payors using alternative names.  MHIS knows the payor names that have changed due to mergers and consolidations.  MHIS knows the PO Box numbers for claims that are not provided by the MCOs. MHIS knows all this and more!

This same information is needed in your claims registrations system.  By subscribing to PayorID.com your staff will not need to spend thousands of hours compiling and searching for this type of information.  Large organizations may also interface PayorID.com data into other internal systems, this processes is known as Insurance MasterCare.

The PayorID.com system empowers your staff to contact and confirm coverage prior to service.  By accessing PayorID.com and searching for a payor name, address, or phone number your staff will know how to contact that plan for authorization or claims verification.

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Our organization does not contract with many MCOs, so why should we subscribe to PayorID.com?

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Verifying patient coverage prior to performing services and billing for services is a prerequisite in order to receive payment in a timely matter.

Verifying coverage and benefits prior to service reduces the potential for lost revenue.  If you do not contract with the patient's MCO, then the patient is responsible for all or part of the bill.  If the patient believes that your organization participates with the MCO, it may prove to be costly to collect payment from the patient.

Some Managed Care Organizations sign reciprocal agreements with other MCOs.  You may actually have a contract with one of thes payors and PayorID.com may help indentify those situations.

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Why do we want claims information on payors we do not have a contract with?

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Business and personal travel place patients outside the service area of their managed care health plan.  Often these individuals have urgent or emergent health care needs.  Generally they will not have an ID card, or if they have the card it may be an old card with an old phone number.  PayorID.com will provide your staff with correct contact information to bill to the correct claims office for the patients MCO.

If the patient is still within the service area, but your organization does not contract with the specific MCO, the level of benefits for the patient may be reduced or eliminated.  Informing the patient at the time of service will resolve some potential collection issues.

Finally, you may identify that you actually have a contract with the payor, because a network that you do contract with actually has a reciprocal contract with another MCO.

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How will PayorID.com  relate to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Plan Identifier?

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The Federal government has talked about a national health plan identifier for several years.   A discussion paper was published (Last Updated March 11, 1998) by HCFA.  Notice of the Proposed Rule Making will be published sometime in the future in the Federal Register.  That Notice will provide an opportunity for public comment on HCFA's (Health Care Financing Administration) proposal for the initiative.

MHIS has created a classification system and compiled information on all the types of health plans discussed in the governments' issue paper.  MHIS provides that solution now.  When the US government finalizes its work and begins assigning payor identification numbers, MHIS will include those identification numbers in PayorID.com.

Your organization does not need to wait for the government to complete its evaluations or develop a payor identification system.  You can start using PayorID.com and/or MHIS Insurance MasterCare today!  We have already created a classification system and will add the National Plan Identifier to the MHIS system.  If you have Insurance MasterCare, you will be able to easily add that to your claims registrations system.

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How much does a PayorID.com subscription cost?

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Monthly access is $75 per month for the first user and $30 per month for each additional user.  

Annual access is $750 per year for the first user and $300 per year for each additional user.  An annual subscription to the Managed-Care Directory book costs $800 and also comes with a one year subscription to the PayorID.com service.  See the order page for other membership options.

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Does the PayorID.com application replace our existing claims registration system? 

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Your existing claims registration system will continue to be used.  PayorID.com compliments your system and serves as a reference system and internet portal to payors.  If you require an integrated solution, then  PayorID.com with Insurance MasterCare will meet your needs.

Interfaces can be established with Insurance MasterCare for McKesson, Siemens, IDX, Meditech, and other claims registration systems.

MHIS will work with your organization to link the PayorID.com database files with the existing files maintained in your claims registration system.   MHIS will develop program logic to automatically revise and add payors to your system as the information about the participants in an MCO change.  Many of the database maintenance functions can flow from programs customized by MHIS to the unique requirements of your organization.  Contact . Joe and the MHIS staff will be happy to prepare a proposal for developing the customized interface(s).

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Can we do patient eligibility verification and claims verification status on-line?

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Yes, a new feature of PayorID.com is on-line eligibility and claims status services for selected payors

MHIS does not charge transaction fees for eligibility verification.  A distinct payor ID and password will be needed for each payor. Your passwords will be entered into a secure database on PayorID.com.  Once each password is established you will be able to log in to each site directly from PayorID.com. Please try this new feature. To view the payors with this feature log on to www.PayorID.com and select the "Online Eligibility" option.From there you can go to the payor's web site and request a password for eligibility.

Current payors that allow on-line eligibility are listed below.  Additional payors will  be added to PayorID.com as they allow this eligibility functionality.

4YourCare Cigna Behavioral Health Medi-Cal
Aetna US Healthcare (professional only) Colorado Access MGIS
Affiliated Healthcare Concentra Preferred Mutual of Omaha
Alliance PPO Corporate Benefit Services of America, Inc MVP Health Plan
Allied Benefit Systems Delta Health Systems Neighborhood Health Partners Florida
Altius Health Plans of Utah Desert Mutual Benefit Associates Nevada Care
Amalgamated Insurance Empire Blue Cross New York New England Financial
Amcare FOCUS Healthcare Management ODS Health Plan
Americas Choice Healthplans GHI Health Plan Oxford Health Plans
Araz Group GM Southwest PacifiCare
AvMed Health Plan Florida Government Employees Hospital Association Pacificare Behavioral Health
Beech Street (preauthorization only) Group Resources Partnership Healthplan
BeneFirst Harvard Pilgrim Passport Health Plan
Benefit Plan Administrators Health Administration Services Penn Western Benefits
Benefit Planners Health Alliance Medical Plans Presbyterian Health Plan
Benefit Systems Health Alliance Plan of Michigan Priority Health of Michigan
Benesight Health First Santa Barbara Health Initiative
Blue Cross Blue Shield of Alabama Health New England SecureCare of Iowa
Blue Cross Blue Shield of Colorado Health Partners Health Plan of Minnesota Sloans Lake
Blue Cross Blue Shield of Delaware Health Plan of Redwoods Tricare Heartland
Blue Cross Blue Shield of Georgia Health Plan of San Mateo Tricare Mid–Atlantic
Blue Cross Blue Shield of Florida Health Plan San Joaquin Tricare Central
Blue Cross Blue Shield of Idaho Health Smart Tricare Northeast
Blue Cross Blue Shield of Iowa HealthKeepers of Virginia Tricare Southeast & Gulfsouth
Blue Cross Blue Shield of Louisiana HealthNet of California Trigon Blue Cross Blue Shield
Blue Cross Blue Shield of Michigan HealthPartners Trigon Blue Cross Blue Shield
Blue Cross Blue Shield of Minnesota HMO Virginia Incorporated Tufts Associated Health Plan Massachusetts
Blue Cross Blue Shield of Nevada Humana Healthcare Plans United Behavioral Health
Blue Cross Blue Shield of Oklahoma Humana Military United Healthcare
Blue Cross Blue Shield of South Carolina Illinois Health Solutions Unity Health Plans
Blue Cross Blue Shield of South Dakota Independent Health of New York Universal Care of California
Blue Cross Blue Shield of Texas Insurance Administrator of America Universal Care of Tennessee
Blue Cross Blue Shield of Vermont Inter Valley Health Plan California ValueOptions
Blue Cross of California Intermountain Health Vytra Healthcare
Blue Shield of California Keystone Mercy Health Plan Wausau
Brown & Toland Medical Group Lifeguard Wellcare HMO
Cannon Cochrane Management Service Magellan Behavioral Health Wellpath of Carolina
Care Choices MagnaCare Western Health Advantage California
Cariten Healthcare Mamsi Wisconsin Physician Services
CBSA McCreary Corporation Zenith Administrators
Central States Southeast & Southwest H&W MD IPA
CHA Health Medicaid Tennessee

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Can PayorID.com help with returned mail claims?

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PayorID.com is the perfect resource to resolve returned mail claims. 

We maintain current claims addresses and phone numbers, so a phone call can be made to access new information.  Many of the pieces of returned mail are a result of typing errors, incorrect addresses, or old addresses.  PayorID.com and/or Insurance MasterCare can be used to clean up payor addresses before claims are mailed.

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Can additional employer information be added to PayorID.com

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Yes.  Many of our clients and potential clients want health plan information on the major employers within their community.  At this time we have approximately 30,000 employers referenced.  The employers listed are generated from other listings that a few managed care organizations release.  Most payors do not provide employers listings.

MHIS will conduct a phone survey of the major employers in a provider's service area.  We will than add and maintain the health benefit and worker compensation carriers offered to various employer groups, along with the appropriate claims processing information affiliated with each payor option. 

MHIS will work with the provider's staff and other organizations such as the Local Chamber of Commerce, to identify a list of potential employers to survey.  The employer name, health plan name, health plan type, and claims office addresses, will be included for each health plan offered to the employer group.

Employer surveys are available for a nominal fee per employer.  For additional  information on employer surveys, contact MHIS today.

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