Keywords: payor code, insurance claims, insurance billing center, clearinghouse, Dental Xchange, Optum
Summary
This article covers how payor codes work in Cloud 9, how to attach them to an Insurance Billing Center, and what to do if a payor code is not yet in your system. Payor codes are required for successful insurance claim submission through the claims clearinghouse.
Payor codes are required for the successful submission of insurance claims through the claims clearinghouse to the insurance provider. Although Cloud 9 uses Dental Xchange as the claims clearinghouse, all payor codes must be verified against the Optum Dental Payor Code list, which can be found here: https://customerconnect.optum.com/payerlist/DentalPayerList
The first time a payor code needs to be added to your system, Cloud 9 Support will need to add it after it has been verified. Once it is in your system, you can attach it to an Insurance Billing Center or Insurance Company following the steps below.
Adding a Payor Code to Insurance Billing Center
Step 1. You can check if a payor code is added into the system by navigating to Edit > Setup > Insurance Billing Center.
Step 2. Search the insurance billing center name in the search bar on the right.
Step 3. Click the tick box to select that Insurance Billing Center and then click 'Edit.'
Step 4. Once you have clicked 'Edit', click the magnifying glass on the payor code field at the bottom.
Step 5. Enter the payor code and click enter.
Step 6. If the payor code appears, select it, and click 'Select', then save the changes in the Insurance Billing Center.
Once you have updated the Insurance Billing Center, navigate back to the patient's Insurance Claim Queue, select the affected/rejected claim, and then Click 'Rebuild' and set the status to 'New' so it can be resubmitted. See THIS ARTICLE for information about the Insurance Claim Queue.
What if the Payor Code is not in my Database?
If you search the payor code and it is not currently in your database, you will need to contact Support so we can confirm and add the payor code to your Cloud 9 URL.
As always, if you have any further questions please do not hesitate to reach out to Cloud 9 Support by emailing us at cloud9support@planetdds.com, or chatting us online using the chat bubble on the lower right at https://cloud9support.planetdds.com/hc/en-us, or giving us a call during our business hours of 8:00 AM EST to 8:00 PM EST at the 1.800.394.6050 option 2.