Payor Assignment History

1. Filter: Here you will be able to filter to Active Only or All.
   
2. Change View: This will change the history from a view like the table above to a list view.
   
3. Payor Information Table: This table will provide payor assignment history once it had been inputted. 
   
4. Action: From here you can view, edit, delete or print a record.
   

Payor Assignment Information

1. Policy: Here there is a drop-down menu that will allow you to choose a policy type.
   
2. Payor: Here there is a drop-down menu that will allow you to choose a payor.
   
3. Payor ID info: Once you choose a payor from the drop-down menu this section will auto-fill with that payors ID, Medical Phone, BH phone, and Claims address. 
   
4. Payor Policy and Group: This section allows you to free text the information for payor policy and group. It also allows you to select the appropriate effective date and term date.
   
5. Policy Type: This allows you to check the appropriate box/boxes for policy type. 
   
6. Policy Holder: This drop-down menu allows you to select policy holder.
   
7. Benefits assigned: This drop-down menu allows you to select Yes or No in regards to benefits assigned. 
   
8. Consent on File: This drop down allows you to choose Yes or No in regards to Consent on File. 
   
9. Guarantor Relation: This drop down allows you to choose Guarantor Relation. 

Service Type

1. Service Type: This allows you to choose the appropriate service type being medical, BH psych provider and BH therapy. 
   
2. Add Authorization Codes: Once a service type is selected the table above for adding authorization codes opens. This table allows you to enter Authorization information and codes. 
   
3. Add or Reset buttons: Add allows you to add the Authorization code to the table list while reset will clear the table above. 
   
4. Remove Authorization codes: This button allows you to remove the codes from the list. 
   

Additional Information 

1.  This section allows you to checkmark on the appropriate box or boxes for additional information. 
   
2. Insurance Type code and Indicator code: This section has drop-down menus to select the appropriate insurance type code and indicator code. 
   
3. Comments Box : Allows you to free text any comments for this page. 
   
4.  Submit/Reset: Reset will remove all the entered fields. Submit will save and input all information.