O-2-150 Request for New Payer Setup

👤 RESPONSIBLE POSITION  |  ROLE

Elig/Auth Coordinator | Authorization Specialist

🎯 PURPOSE

When a new payer needs to be added to the database in Home Care Home Base (BCBS), use the Request for New Payer Setup Form to request the new payer be set up in HCHB. The steps to complete this are described below.

🔄 PROCESS

1. Open the form and save-as to another location so that you can save your changes as you fill it out.
2. The form is fillable. Complete, to the best of your ability, all fields below. Try to obtain as much information as possible, as provided by the payer themselves.
   1. Requested by: Branch and Person: Enter the branch number and the name of the person completing the form.
   2. Branch-Specific Payer or National Payer: Check whichever box applies to the payer.
   3. Payer Name: Enter the name of the Payer.
   4. Provider Contact Name: Enter contact name, if applicable.
   5. Provider ID: Enter the Tax ID or NPI number.
   6. Address: Enter complete address where the bill should be sent.
   7. What type of invoice do they require: Check the appropriate type.
   8. Select payer class: Check the appropriate type.
   9. Authorized skills/codes and rates: Enter all required information in appropriate column.

3. After filling out the form, send the form to support@adarahomehealth.com.
4. The billing team will follow up to set up the new payer, and will reach out if they have follow-up questions.

📅 Effective: 12.22.2010  | 🛠️ Revised: 10.23.2026 |  ✅ Approved: JFJ