Billing

Managing your revenue cycle

This section captures all the important details required to manage your Revenue Cycle. This section is only accessible to admin users. This guide outlines the standard configuration for the Billing tab in Fieldworker. Use this as a template to ensure your agency's billing and compliance data is accurately maintained.

1. Agency Identification (Billing Information)

This section houses the primary identifiers required for state and federal claim submissions.

• NPI (National Provider Identifier): Your agency's unique 10-digit identification number.

• Taxonomy Code: The alphanumeric code that identifies your agency's specific specialty or service type.

• ZIP9: Your agency's full 9-digit postal code, often required for accurate geographical reimbursement rates.

2. Global Billing Settings

Configure how billing data is displayed across the platform.

• Prior Authorization Date Range View: Determines the default calendar view (Month or Week) when managing authorizations and unit tracking.

3. Payer Management

This section allows you to manage the insurance carriers and government programs your agency works with.

Supported Payers

Fieldworker is designed to be payer-agnostic, meaning it supports any payer that requires HIPAA-compliant billing. You will be selecting your payers based on the state your agency operates in, and those payers are supported by the Fieldworker's Clearinghouse. Common integrations include:

• State Medicaid: Full support for New Jersey Medicaid (DMAHS) and other state programs.

• EVV Aggregators: Direct compatibility with HHAeXchange and other state-mandated aggregators.

• Private Insurers: Managed Care Organizations (MCOs) and private commercial plans.

Key Payer Fields

For each payer added, you must maintain:

• Payer ID: The electronic routing ID for claims.

• Enrollment Status: Tracks whether your agency is currently credentialed to bill that payer.

• Contact Info: Includes the Payer Address and TaxID for paper claim fallbacks.

4. Credentials

Secondary identifiers used for secure data exchange and specific program reporting:

• Business Entity ID & Medicaid Identifier: Specific IDs assigned by the state or clearinghouse.

• Client ID/Secret: Used for API integrations with external billing clearinghouses.

5. Contract Tracking

Use this section to monitor active agreements and prevent "billable gaps" due to expired contracts. A contract usually connects a process performed by your agency to its own dedicated NPI, if any.

• Type: Categorize by NPI (general) or Medicaid (state-specific).

• Start/End Dates: Essential for audit readiness; the system uses these to validate that a service was covered by an active contract at the time of the visit.

To add and configure a new payer in the Fieldworker Billing Settings, follow this guide to ensure your claims route correctly through the claims.io clearinghouse.

Guide: Adding a New Payer

Adding a payer involves two key steps: creating the payer profile and linking the necessary credentials for electronic submission.

Step 1: Initialize the Payer Profile

1. Navigate to the Billing tab within your Settings.

2. Scroll to the Payers section and click the [+ ADD NEW PAYER] button.

3. In the pop-up modal, enter the following required details:

   • Payer Name: The official name of the insurance carrier or program.

   • Payer Tax ID: The specific Federal Tax ID used by the payer for processing.

   • Payer ID: The unique electronic routing number (essential for claims.io to deliver your claim).

   • Payer Address: The full mailing address, including ZIP code.

Step 2: Set Contact & Enrollment Dates

Fill in the administrative details to help track your agency's relationship with the payer:

• Contact Name & Phone: The primary point of contact at the insurance company for billing disputes.

• Start & End Date: Define the period during which your agency is authorized to bill this payer. Fieldworker uses these dates to validate claim eligibility.

Step 3: Configure Electronic Credentials

For the payer to communicate with the claims.io clearinghouse, ensure your Credentials section is up to date:

• Business Entity ID: Your agency's specific ID within the clearinghouse.

• Medicaid Identifier: If the new payer is a state Medicaid program, enter your provider-specific Medicaid ID here.

• Client ID/Secret: Ensure these are correctly "mapped" so that Fieldworker can securely push data to claims.io.

Quick Reference: New Payer Checklist

Field	Importance	Why it matters
Payer ID	Critical	Determines where claims.io sends the electronic file.
Payer TaxID	High	Required for Box 25 of the CMS-1500 form.
Start/End Dates	High	Prevents billing for services outside of active contract windows.
Contact Email	Medium	Used for receiving electronic remittance (ERA) notifications.

Guide: Adding Billing Credentials

To enable electronic claim submission through claims.io, you must configure your agency's unique credentials within the Billing settings. This "handshake" allows Fieldworker to securely transmit sensitive health data to the clearinghouse. The Add Credentials workflow links your Fieldworker account to your payer profile.

1. Accessing the Credential Portal

1. Navigate to the Billing tab in Settings.

2. Click the [+ ADD NEW PAYER] button.

3. In the top-right corner of the "Add New Payer" modal, click the blue [ADD CRED] button to toggle the credential fields.

2. Required Credential Fields

Fill in the following technical identifiers provided during your claims.io onboarding:

Field	Description
Client ID	The unique public identifier for your agency's claims.io account.
Client Secret	Your secure private key (this field is encrypted for security).
Business Entity ID	Your specific organization ID within the clearinghouse network.
Medicaid Identifier	Your agency's state-issued Medicaid provider number (if applicable).
Contact Email	The primary email address for receiving automated billing alerts and ERA notifications.

3. Saving and Validation

• Once all fields are populated, click [ADD CREDENTIALS].

• Success Check: Once saved, these details will appear under the Credentials header on the main Billing page.

• Security Note: The Client Secret will be masked (e.g., ********) after saving to protect your account integrity.

Important Maintenance Tips

• Credential Rotation: If you reset your password or API keys in the claims.io portal, you must immediately update the Client Secret here to prevent claim submission failures.

• Email Accuracy: Ensure the Contact Email is a monitored inbox (like [e-mail]), as this is where rejection alerts are often routed.

Guide: Adding a Contract

To complete your billing configuration, you must document the Contract Tracking section. This is the final layer of validation that ensures every service provided is backed by a legal agreement, preventing "billable gaps" and ensuring audit readiness. Contracts in Fieldworker link a specific billing identifier (NPI or Medicaid ID) to a set validity period.

1. Locate the Contract Section

1. Scroll to the bottom of the Billing tab in Settings.

2. You will see two categories: NPI Contracts and Medicaid Contracts.

3. Click the [+ ADD NEW] button next to the relevant category.

2. Enter Contract Details

Fill in the following fields to define the scope of the agreement:

Field	Description
Contract ID / Number	The unique identifier assigned to the contract (e.g., your specific Medicaid Provider Number or a private payer agreement ID).
Start Date	The first date the contract becomes effective for billing.
End Date	The expiration date. Fieldworker will flag services provided after this date as "non-billable."
Notes (Optional)	Use this for internal reminders, such as "Requires renewal 90 days prior" or specific service limitations.

3. Validation & Status

• Active Status: Once saved, the contract will appear in the list. The system automatically compares the current date against the End Date.

• Expiration Alerts: Contracts that have passed their End Date will often be highlighted or flagged.

  Note: Always ensure there is no gap between the End Date of an old contract and the Start Date of a renewal to maintain continuous billing cycles.

Summary of the Billing "Chain"

For a claim to be successfully sent to claims.io, the system checks these three things in order:

1. Credentials: Is the "bridge" to the clearinghouse open?

2. Payer: Is the Payer ID and Tax ID correct for routing?

3. Contract: Is there an active contract covering the date of service?