Setting up Payer rules is essential in ensuring that your practice is set up for success. This process should be completed for all payers, but will only need to be completed once for the settings to take effect. Payer rules can be changed at any time, and changes made will take effect immediately.
If you have a third-party biller, they may assist you with this process. We recommend contacting your third-party biller directly for clarification on if they will set up these rules for your practice.
Note: Only users with the "Site Administrator" Permission within Stride will be able to perform these actions.
Terminology:
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Basic Information – This is where you set up the standard billing procedures for each payer.
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- Billing Profile – the default profiles of GP and Medicare will be assigned to payers which auto-apply modifiers and CPT rules. The "Medicare" profile includes GP modifiers AND all Medicare CCI edits. The GP profile ONLY includes GP modifiers.
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Set the Unit Calculation Rule – CMS 8 minute rule or SPM (also known as AMA). You also have an "either" option where Stride will auto-calculate the best unit combination for clinicians whenever they click the "Calculate Units" button at sign off. We recommend keeping things set up how they were in your previous system, unless you wish to make changes at this time.
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Billing Rules & Configuration – This is where you can set default requirements for a payer, such as when Authorizations should be obtained and if a Referring Provider is required to be on the claims.
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- Auth Requirements – Stride has three options: Required prior to eval, Required after eval, or Not required. Stride defaults to not required so please ensure you update this for payers requiring authorization. Once a payer has an Authorization requirement added, the Admin staff and the clinical staff will get alerts to manage these authorizations. This also ensures that Stride will catch any claims without authorizations attached and require them to be added before the claim can be billed out to the clearinghouse.
- Referring Provider – This ensures the referring provider is listed on the claim. In most cases, this should be set to "Yes" for all Federal payers such as Medicare.
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Compliance Alerts – These are designed to follow Medicare’s rules; setting these to Active will turn on alerts. If you choose to set these as Required, this will force therapists to take the necessary action in order to sign off their note. Please choose the settings that fit best for each payer and your practice's guidelines.
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- Certification Alerts – Set the maximum duration for a POC. Stride's default setting is 90 days, but you can change this for any payer if you wish.
- Progress Note – Set the frequency of progress note requirements. Stride's default setting for Progress Notes is 10 visits, but you can change this if you wish. Changing this comes in handy for Worker's Comp payers, who sometimes may require a Progress Note every 5 visits instead of the standard 10.
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Watch how here:
Next (Stride Billing Clients Only): 10. How To Map Payers To The Clearinghouse (Stride Billing Clients Only)
Next (Clients Without Stride Billing): Post Launch Admin Items
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