Payers Overview

They are used to organize patient data and support filtering, routing, and reporting across the platform.

Why Payers Matter

Payers provide a detailed view of how patients are covered. They are commonly used to:

• filter patients and leads

• segment performance and reporting

• support scheduling and operational decisions

Because payer data can be very granular, it is often paired with Groups to simplify reporting.

What a Payer Represents

A payer is typically a specific plan, not a broad category.

Examples:

• Aetna Medicare Advantage

• BCBS PPO (specific state/plan)

• A direct contract with an employer

• Self Pay

This means you may have many payers that fall under a single broader category (like Medicare or BCBS). Using Groups helps simplify reporting around this dimension.

How Payers Are Created

Payers are often:

• pulled in from EMR integrations

• backfilled from existing patient data

In most cases, teams do not need to manually create or maintain a large number of payers.

However, it is still useful to understand how they appear and how they are used in filters and reporting.

How Payers Are Used

Payers show up in multiple places, including:

• patient records

• lead and intake data

• filters across dashboards

• reporting views

They allow teams to answer questions like:

• Which insurance types are driving volume?

• Are certain payers converting better than others?

• Are there operational differences by payer?

Payers can also be used as a dimension in Booking Rules to help shape your schedule based on your business rules and contractual obligations. More on Booking Rules in this article.

Payers vs Groups

Payers are detailed. Groups are simplified.

For example:

• Multiple Aetna plans → grouped under “Aetna”

• Multiple Medicare Advantage plans → grouped under “Medicare”

If reporting feels too fragmented, Groups are typically the right place to simplify it.

Best Practices

• Expect a large number of payers — this is normal

• Use Groups to simplify reporting and analysis

• Focus on payer categories for decision-making, not individual plans