Note: the Payer list can be “seeded” initially using a CSV from a billing provider or the lab. After the initial setup, it is the lab’s responsibility to curate the list and to ensure that all information in the Payer list is accurate and up to date.
Payers can be added, updated, and archived in Dendi LIS. Any included payers will be displayed in all instances of payer dropdowns or lists. For example, in order create workflow, a “Test Payer” that has been created to demonstrate this functionality can be seen:
Careful curation of Payers is important because it allows the lab to bill correctly and to avoid duplicate or incorrect information. This ultimately leads to improved adjudication success.
Aliases can be defined for a Payer to help people creating Orders find the correct Payer object. For example, you might have a Payer named “BCBS North Carolina”, and aliases could be “BCBSNC”, “Blue Cross Blue Shield NC”, etc. Whenever an Order creator searches for either the name or the alias of a Payer, “BCBS North Carolina” would show in the dropdown.
The Payer Code is a field used by billing companies to map an insurance company by name to their internal system. For example, one system may refer to BCBS of North Carolina as “BCBSNC” - the payer code is used as a “master reference” to remove potential duplicates. In Dendi LIS, this field is optional.
As with other parts of the user interface, a user can add internal notes and comments to each Payer record.
Each individual Payer Details page will contain a list of Orders associated with said Payer. You can filter this table similarly to the main Orders table to drill down further as needed.
When creating an Order, a user can search for an existing Payer to add insurance information for the Order’s Patient. Only Verified Payers will show up as search results. To mark a Payer as verified, click on the yellow edit button for that specific Payer, then check the “Verified Payer” checkbox.
Internal users creating Payers will always create Verified Payers. External users (Account Admins, Providers, Collectors) will create Payers that are initially unverified.
The Verified Payer guardrail exists to prevent pollution of the Payer list, as any user creating an Order can create a new Payer on the fly. These created but unverified Payer objects will show up in the Payer list for lab staff to evaluate and verify if necessary.