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?
   • The Non-Par Processing Fee is calculated based on each unique Rendering NPI (National Provider Identifier) and Tax ID combination used for claim submissions. If no Rendering NPI (or Attending NPI for Institutional claims) is available, the Billing NPI will be used instead. The fee is charged if 50% or more monthly claims are submitted to a non-participating payer for the NPI + Tax ID combination.
   • Effective 1/1/2026: The Non-Par Processing Fee will be calculated based on each unique Rendering NPI (National Provider Identifier) and Tax ID combination used for claim submissions. If no Rendering NPI (or Attending NPI for Institutional claims) is available, the Billing NPI will be used instead. The fee will be charged when any claims are submitted to a non-participating payer for the NPI + Tax ID combination.
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:
   • Example 1: Cigna is a non-participating payer. If 50% or more of the claims for a unique Rendering or Attending NPI + Tax ID combination are sent to Cigna, that NPI + Tax ID combination will incur the fee.
   • Example 2: Aetna is a participating payer, if over 50% of the claims for a unique Rendering or Attending NPI + Tax ID combination are sent to Aetna, that NPI + Tax ID combination will not incur the fee.
   • Example 3 (Post 1/1/2026): Cigna is a non-participating payer. If any claims for a unique Rendering or Attending NPI + Tax ID combination are sent to Cigna or any other non-participating payer, that NPI + Tax ID combination will incur the fee.

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.