Payor Management

Payor Management for the Kipu CRM covers adding and managing your insurance payors list. The insurance provider is known as the Payor and is responsible for benefits and financial coverage for the client while in treatment. 

Important: The Payor Management process is tied to the payor list, which in turn connects to the CRM and EMR and then to the billing service.

Payor Administration

The Tenant Payor list is known as the master tenant payor, which is a list of payors the agents can use in the system.

1. Navigate to Admin > Payor Administration.
   
   
   • Important: Make sure that the payor list in the EMR, or any other product, matches the Payor list in the CRM to ensure that the system is mapping to the correct payor.

Payor Process

1. You can choose to Import Payors Clone Payors or Add Payors. The payor management process is connected to the payor list which is also connected to the CRM and EMR and then the billing service.
   
   
   • Important: Whenever possible, import a payor before adding it. Doing so will increase the likelihood that the payor will support instant VOB because it populates the entire clearing house list. Click here for more information on VOB.

Importing Payors

Important: Whenever possible, import a payor before adding it. Doing so will increase the likelihood that the payor will support instant VOB because it populates the entire Clearing House list.
Click here for more information on VOB.

1. 1. Navigate to Admin > Payor Administration.
      
   2. Once inside the master payor list, you will land on your current tenant payor list. 
   3. Select Import Payors.
   4. You can use the name field to search for a particular payor.
   5. Search for a payor that supports instant VOB. You can do this by using the COV column and selecting Yes from the drop-down list.
      
   6. Once the results are filtered, you will only see the payors who support VOB. You can identify these in the Coverage column.
   7. Be sure to check the inactive names as well, as some payors may not show up on the active list.
   8. Once you locate your payor, click on the Import button.
      • Important: Whenever you import a payor, it represents itself as a master source. Adding a payor will cause the source to list itself as a manual. Manual payors will not support VOB as they are not connected to the clearing house.

 BCBS Insurers

Important: When importing payors, make sure to access the payor and verify that the Is BCBS toggle is set up accordingly. If set to Yes, the eligibility check for patients with this insurance payor will run through your facility's local BCBS plan set up in the system. If set to No, the system will run eligibility checks (e.g., instant VOBs) directly through the payor in question.

Matching Payors

Matching payors is used to confirm that the information inside of the EMR matches the payor information inside of the CRM to ensure proper synchronization between all billing platforms.

1. Once you've imported your payor, click on them to open the information panel. Select See Details.
2. Next, ensure that you're on Payor Information. This is particularly important for integrated billing clients.
3. Once you're in the Add/Edit Tenant Payor screen, open the EMR and enter the matching payor into the CRM. Make sure that you enter all the information correctly to ensure that the instant VOB runs properly. Be certain to include whether or not the client is a Blue Cross Blue Shield patient.
4. After the payor has been set up in CMD and the EMR, the last step is to make sure the CRM payor matches the EMR Payor. This step ensures that the proper payor information is transferred.