Partner Lookup Table
Serves as system holder of basic claims-related data around the system and customer partner entities (insurance companies or TPAs). The ID here matches the ID in CHC, and this entry maps unique payerID values to specific CHC trading partners.
Field | Description | Acceptable Values | Notes |
partnerLookupID | Internal Lookup ID that maps to PartnerServices.partnerLookupID. | Used by Partner Services to determine which PartnerLookup record to use. | |
payerName | Internal display name | Assigned during configuration. No mapping to CHC. | |
tradingPartnerId | The CHC ID used in actual transactions. | Assigned during configuration. No mapping to CHC. | |
payerId | The payerID value in the EF. | Key used by the system to identify this record. PayerID for whom we’ll submit claims to. Maps to CHC PayerID. | |
changeHealthcareEligibiltyPayerID | Payer ID for payer with whom eligibility checks should be performed against. | Maps to CHC Eligibility Realtime Payer ID. | |
changeHealthcareClaimsPayerID | Payer ID for claim payer - Who claims will be submitted to. | Maps to CHC CPID and CHC Claim Status Payer ID. |
Relevant Process
Use the payerID to find a matching partnerLookup record.
Relevant Configuration
Refer to the Partner Services section within the Account Management Tool for more information.
Multiple PayerIDs in the same Contract/Eligibility File
Configuration exists to support instances where one contract/EF contains multiple payerIDs to support claims submission.
Example:
The customer 98point6 Bakery contractID 111 submits an eligibility file that has both BCBS (payerID 222) and Aetna (payerID 333) HSA members. To support claims submission to both Payers associated to this contract/EF:
Create a Partner Services record for contractID 111.
Create an associated PartnerLookup record associated with payerID 222.
Create a Partner Services record for contractID 111.
Create an associated Partner Lookup record associated with payerID 333.
Example Partner Services Record:
Account Management Tool (AMT)
Refer to the Partner Services section within the Account Management Tool for more information on how to add, update, and delete partner services and partner lookup entries.