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Set up a payor

A payor is the person, company, plan, or program responsible for paying for all or part of a patient's care. Payors are used when you add patient coverages, set up billing periods, track authorizations, and review billing information.

Before you start​

You need:

  • An organization. See Set up an organization.
  • Admin access to add a payor.
  • The payor name and type.
  • Patient-specific benefit details if you also plan to add a coverage after creating the payor.

Medicare Part A and Medicare Part B are pre-loaded in new organizations, so you do not need to create them manually.

Choose a payor setup workflow​

There are two ways to set up a new payor in RehabAlpha:

  • Manual setup: Add the payor directly in RehabAlpha. Use this workflow when you are entering one payor or want full control over the payor name and type as you create the record.
  • Import: Upload one or more files with payor information using the import tool. This is explained in Import data.

The steps below explain the manual setup workflow.

Manually create a payor​

  1. Open Payors.
  2. Click New payor.
  3. Enter the payor Name.
  4. Select the payor Type.
  5. Add tags or notes when helpful.
  6. Click Save.

RehabAlpha creates the payor and adds it to the organization's payor list.

Choose the payor type​

Choose the Type that best describes how the payor should be handled in billing and reporting workflows.

  • Use Commercial Insurance for standard commercial plans.
  • Use Managed Care Part A or Managed Care Part B for managed Medicare plans.
  • Use Medicaid for Medicaid payors.
  • Use Medicare Part A or Medicare Part B only when you need a separate Medicare-related payor record beyond the pre-loaded options.
  • Use Private Pay when the patient or another private party is responsible.
  • Use Workers' Compensation for workers' compensation coverage.

The payor type helps RehabAlpha apply billing rules and group payors for reporting.

Understand payors and coverages​

A payor record identifies who may pay. A patient coverage record describes when that payor applies to a specific patient and what benefit details are available.

Keep the payor record focused on the payor name, type, tags, and notes. Enter patient-specific details on the patient's coverage, such as:

  • coverage start and end dates
  • deductible
  • copay
  • coinsurance
  • out-of-pocket maximum
  • authorizations

Add the payor to a patient coverage​

After the payor exists, use it on the patient's coverage record.

  1. Open the patient.
  2. Click Coverages.
  3. Click New coverage.
  4. Select the payor.
  5. Enter the coverage start date and end date when known.
  6. Add deductible, copay, coinsurance, out-of-pocket maximum, or authorization details when needed.
  7. Click Save.

Manage payor details​

  1. Open Payors.
  2. Find the payor in the list.
  3. Click the payor name.
  4. Click Details.
  5. Click Edit.
  6. Update the payor name, type, tags, or notes.
  7. Click Save.

Changing a payor's name or type affects how that payor appears anywhere it is used in RehabAlpha.

Manage payor settings​

  1. Open the payor.
  2. Click Settings.
  3. Update the available settings for that payor.

Depending on your permissions, the settings page may include danger-zone actions.

You should know​

Only admins can add or delete payors.

Medicare Part A and Medicare Part B are pre-loaded in new organizations.

Do not delete a payor if it is still needed for patient coverages, billing periods, authorizations, or reporting.

Do not create a separate payor for each patient unless the payor itself is actually different. Use patient coverages for patient-specific policy periods and benefit details.

Frequently asked questions​

Do I need to create Medicare Part A or Medicare Part B?​

No. Medicare Part A and Medicare Part B are pre-loaded in new organizations.

Where do I enter deductible, copay, coinsurance, or authorization details?​

Enter those details on the patient's coverage. The payor record stores the payor name and type. The coverage stores patient-specific dates, benefits, and authorization limits.

Can I import payors instead of entering them manually?​

Yes. Use Import when you have one or more source files that include payor information. Review imported payors before using them for coverages, billing periods, authorizations, or reporting.

Can I change a payor type later?​

Yes. Open the payor, click Details, click Edit, update the Type, and save. Review related coverages and billing setup if the type change affects how your organization expects to use that payor.

Can I use one payor for multiple patients?​

Yes. Create one payor record for the payer organization or responsible party, then use that payor on each patient's coverage as needed.

What to do next​

After creating the payor, add it to patient coverages and use those coverages when setting up billing periods or authorizations.