What Is a Payer Network?
A payer network is a group of providers that an insurance company has contracted with to deliver services at negotiated rates.
In simple terms:
It is the “approved provider list” associated with a client’s insurance plan.
- If a provider is in-network with the client’s plan, services are typically covered at a lower cost.
- If a provider is out-of-network, the client may pay higher costs or need to handle claims differently.
Why This Matters for Support Teams
Payer network information directly impacts day-to-day operations, including:
- Scheduling the correct type of client
- Providing accurate cost estimates
- Verifying in-network vs. out-of-network status
- Preventing unexpected billing issues for clients
- Ensuring proper handling of insurance verification and eligibility questions
Viewing and Managing Networks
Access the Networks Page
Navigate to:
EHR → Payers → Networks
On this page, you can:
- View existing networks
A list of payer networks used within the practice will be displayed. - Add a new network
Click “Add a network” to create a new payer network. - Edit an existing network
Select the edit icon to update the network name. - View attached payers
Click into a network to view its details, including the list of payers associated with that network. - Associate payers with a network
After creating a network, go to the Payers page to assign payers to the appropriate network.
This organization helps ensure payers are properly structured within the system, supporting accurate insurance processing, billing workflows, and client communication.