Difference between CPID and Payor ID?

[prosete]

What is the difference between an insurance plan's Payer ID and Claims Payer ID (CPID) when submitting claims electronically?

For example, the CPID I have in my Medisoft database for all United Healthcare affiliates and plans is a 4-digit number <3426>, whereas the United Healthcare website's Claims Payer List shows only a 5-digit number <87726> as the Medical Payer ID (vs. Dental Payer ID) for all its affiliates in the US. Third-party websites, such as Dibbs Solutions Clearinghouse, also show UHC 's CPID as <3426> and its Payer ID as <87726>. Same for different states' Medicare claims submission ID's, i.e., Medicare FL shows <1458> and <00590> for its CPID and Payer ID, respectively, and AZ Medicare has them as <1456> and <03102> in similar fashion.

So, which ID is responsible for directing a claim to the desired insurance plan?

TIA

[Gavin Walker]

The CPID is short for Claims Payer ID and that is what goes in the Claims Payer ID field in Medisoft. The Payer ID is often the ID that is printed on the insurance card. So you can use the Payer ID to look up the CPID at Change Healthcare. So if the Payer ID is 87726, looking up by that at Change Healthcare reveals 3429 for the CPID for Professional Claims and 3550 for Institutional Claims. Most small practices should be filing Professional Claims so 3429 would be the CPID in most cases. Note, there are many different plans that all boil down to the same CPID. There is probably different Payer IDs and CPIDs for United Healthcare plans that are Medicare replacement or supplemental plans.

Note, also, 3429 requires an enrollment with that payer, so you probably need to do that too.

PS, always look up the CPID at Change Healthcare's website to get the latest and most accurate information.