Understanding Par vs. Non-Par Processing Fees

This article explains the difference between the Par (Participating) and Non-Par (Non Participating) payers in regards to potential processing fees in Office Ally.

Understanding the Non-Par Fee:‍

1. What is the Non-Par Fee?
   • A Non-Par fee is a monthly fee that is charged when 50% or more of your monthly claims are submitted to non-participating payers.
2. Non-Participating Payers:
   • Non-participating payers are identified by the Non-Par check mark next to their name on the Payer List page.
3. To view the Payer List:
   • Log into Service Center.
   • Expand Resources from the left-hand side menu.
   • Select Payer List from the dropdown.
   • From the list, navigate to the Non-Par column. Non-par participants will have a checkmark.
4. Non-Participating Payer Charges:
   • Non-Par charges are incurred if 50% or more of your monthly claims are submitted to a non-participating payer. This fee is calculated based on each unique Rendering or Attending NPI (National Provider Identifier) and Tax ID combination used for claim submissions. If no Rendering NPI is available, the Billing NPI will be used instead.
   • Example 1: Cigna is a non-participating payer. If 50% or more of your claims are sent to Cigna, you’ll incur the fee for the unique Rendering or Attending NPI + Tax ID combination.
   • Example 2: Aetna is a participating payer, so submitting 50% or more claims to Aetna will not result in a Non-Par fee for the unique Rendering or Attending NPI + Tax ID combination.

Important Note:

• The Par/Non-Par status can change over time. It's important to regularly monitor the payer's status, as a Par payer may switch to Non-par, potentially resulting in unexpected additional fees.