📝 Overview
A third party payer is any entity responsible for a claim that is not the patient. You must create a payer before you can add a patient’s insurance policy, bill claims, post EOBs, or run insurance reports. This article covers where to create payers and what each field on the payer screen does.
🧭 How to Get to Third Party Payers
You can manage payers at two levels:
System level (shared by all locations): Go to your System Dashboard → Insurance → Settings → Payers. Click Create System Payer.
Location level (specific to one office): Navigate to your Live Location → Insurance tab → Settings → Payers.
At the location level you’ll see both System Payers and Location Payers. If your system restricts location-level payers, only System Payers appear.
⚠️ Some systems turn off location-level payer creation under System Settings → System Configuration → Locations Can Add Payers. When it’s off, only a System Admin with insurance permissions can add payers. Location Admins can’t edit system-level payers.
👥 What Counts as a Third Party Payer
Health insurance companies
PI (Personal Injury) insurance carriers
Worker’s Compensation carriers
Attorneys managing PI or WC claims
Common examples: United Healthcare, Blue Cross Blue Shield, Medicare, Medicaid, local law firms handling PI cases, and Worker’s Compensation carriers.
➕ Adding a New Third Party Payer
Enter the following:
Name: Full name of the insurance company or attorney.
Short Name: Abbreviated name, if preferred.
Payer Group: Groups related payers together. Select an existing group or create one. Group names must be unique.
Payer Type: Group Health, Medicare, Medicaid, Auto, Attorney, etc.
Contact Name: Specific contact person, if available.
Specific to (State): Defaults to “All” unless otherwise specified. If you choose a state, the payer only appears for offices in that state.
Phone Number / Fax: From insurance cards or benefits verification.
Address / City / State / Zip: Mailing address where claims are sent for paper billing.
Default Billing Method: Choose how claims to this payer are billed by default. Electronic is the default. This setting also determines how claims are organized in your Create Claims queue. Payers set to Electronic appear together in one queue, and payers set to Paper appear in another.
Electronic: Shows the Clearinghouse Payer ID field. Enter the payer ID from your clearinghouse. If you leave it blank, the claim goes to the green sheet when you batch and submit.
Paper: Hides the Clearinghouse Payer ID field. Use this for payers that require mailed claims, and make sure the mailing address is complete.
The checkboxes below are payer-specific requirements. You usually don’t need them until a payer starts rejecting claims. If a payer rejects claims for one of these reasons, check the matching box, then rebill the rejected claims.
Single Day Bills: This feature is now standard, so you don’t need to check this box. A single-day bill puts one patient and one date of service on each HCFA form, even when you batch bill. It does not combine multiple dates of service.
Force Render Box 32: ChiroHD’s integration with clearinghouses leaves Box 32 blank when the information in Box 32 and Box 33 is the same. Clearinghouses specifically requested this format, and it works for most payers. Leave this unchecked by default. Check it only if a payer rejects claims because Box 32 is blank. Once it’s checked, you must rebill rejected claims, and all future claims submitted to that payer include the required information in Box 32.
Requires Referring Provider: Not required by default. Check it if a payer rejects claims and says a referring provider is required. Once it's checked, you must add the referring provider under the patient's policy setup, then rebill the rejected claims.
Uses Provider Taxonomy Codes: Check this if a payer rejects claims because a provider taxonomy code is required on the claim. After you check it, go to your Live Location → Settings → Providers and make sure each provider has a taxonomy code entered. Then rebill the rejected claims.
Uses NPI2 Taxonomy Codes: Check this if a payer rejects claims because an NPI2 (group) taxonomy code is required on the claim. After you check it, go to your Live Location → Settings → Providers and make sure each provider has a taxonomy code entered. Then rebill the rejected claims.
🩺 Credentialing at a Glance
Your payer and provider screens show credentialing relationships in both directions, always in sync.
On the payer screen, see every provider your office has set up as credentialed with that payer.
On the provider screen, see every payer your office has set up for that provider.
Update either screen and the other reflects it immediately.
Credentialing here is office-managed. Your team enters which providers are credentialed with which payers, and ChiroHD displays that information. ChiroHD doesn’t connect to any external credentialing database or verify credentials independently.
🔀 Merging Third Party Payers
You can merge payers at the system level or the location level.
Open the Payers screen at the level you’re working in.
Open the Merge Third Party Payers window.
In Keep this Third Party Payer, search for and select the payer you want to keep.
In Merge this Third Party Payer, search for and select the duplicate.
Click Merge Third Party Payers.
Merging does not remove payers from claims you’ve already submitted, and it doesn’t delete any past history. If you need to resubmit claims after a merge, you can.
⚠️ Important Reminders
If one insurance brand has multiple divisions or addresses (like Blue Cross), create a separate payer for each.
A payer that has been added to claims can’t be deleted. This keeps your claim history intact.
If you get a “must supply a unique name for your payer group” error, add a descriptor to the name, such as “Aetna (Primary).”
Accurate setup means claims bill correctly, EOBs post accurately, and reports pull the right payer data.
🔎 Can’t Find a Payer in the Dropdown?
Confirm the payer exists under Third Party Payers at the system or location level.
Check Specific to (State). If it doesn’t match your office’s state, the payer is filtered out.
Type the full payer name instead of the first few letters.
Click the patient case first, then Add Insurance Coverage.
If none of that works, the payer may not exist in ChiroHD yet and needs to be created.
📌 Conclusion
If the payer accepts electronic claims, keep Electronic selected and enter the payer ID before you batch. If the payer requires mailed claims, select Paper. Leave Single Day Bills, Force Render Box 32, Requires Referring Provider, and the taxonomy checkboxes alone until a payer rejects claims for that reason, then check the matching box and rebill. If a payer is missing from the dropdown, check that it exists, then check its Specific to (State) setting. If you have duplicate records for the same payer, merge them.
A few items are still unconfirmed:
Phone Number / Fax placement on the screen. I put it right after Specific to (State).
“HCFA form,” since the transcript said “HIPAA form.”
The two taxonomy checkbox labels. I used the labels from the override screen and the current checkbox in the code.