Payer billing profiles & modifier rules
You can customize how you want modifiers to be applied on a payer by payer basis. You can create a Billing Profile to set rules one-time and apply that profile to many payers. Stride provides 2 billing profiles to start: (1) “Medicare”, which includes CCI edits and GP auto-assigned, and (2) “GP Modifiers”, which includes only GP auto-assigned
For each billing profile and payer you can set:
- 59 code pairs
- Disallowed code pairs
- Auto-applying modifiers
- Disallowed codes
For each individual payer you can use a billing profile as a starting point, e.g. Medicare, and make custom overrides just for that specific payer.
Setting Payer Rules:
Mapping Payers To Clearinghouse: