We highly suggest that you check the provider maintenance page set up prior to starting claim submission to ensure that all claims are submitted correctly.
This part of the setup allows the administrators to enter all applicable data for the rendering and billing providers.
To check the provider maintenance follow these steps:
Click the Administration Tab and look for Provider Maintenance.
Click the edit icon under options.
Select the Provider/Submitter Roles
The role selection allows the user to designate where the NPI can be used on a claim form:
- Billing/Organization/Group/Box 33 allows the data to be used as a billing provider in box 33.
- Rendering/Servicing allows the data to be used as a rendering provider in box 24, 31.
- Dual allows the data to be used in both areas.
- Check the box to set the Practice’s default Rendering Provider on charge entry. Selecting a default is optional and one is allowed per office.
Select the type of the NPI - Individual or Organization/Group
- An individual physician/provider requires the First and Last Name = Type 1 NPI
- A hospital/facility/organization requires the Organization Name = Type 2 NPI
- Enter the NPI. When the NPI is entered, the First Name, Last/Organization Name, Taxonomy code, and License State/Number will be auto-filled. This data pulls from the NPPES online Registry and needs to be reviewed for accuracy.
- Enter Tax ID code
- Confirm the Name
- Confirm the Taxonomy Code
- In order to save the provider's First Name and Last Name, it cannot contain anything other then their actual name (no Jr, Sr, or Credentials, etc.).
- Select Default Billing Location (This address will fill box 33 address lines). This address is pulled from Administration: Locations.
- Enter the desired Direct Message address.
- Once the Direct Message address has been set up, users may associate other users to this address in order to send messages on behalf of those providers. This can be done via Admin: User Maintenance.
Optional Fields – Default Settings for Charge Entry/Claims/Statements
- Default Rendering Location populates the service location on charge entry.
- Default Billing Provider populates the Billing Provider when this rendering NPI is selected in charge entry.
- Default Rendering will populate the rendering provider when this billing NPI is selected.
- Default Referring will populate the referring provider when this NPI is selected.
- Billing Provider is not the Pay-To Provider. It will populate a Pay-To provider when this NPI is selected. If the Billing provider is the same as the Pay-To, this option should not be selected.
- Rendering Provider requires a Supervising Provider will populate a supervising physician when this NPI is selected.
- Indicate the default statement location for the rendering provider.
Optional Fields – Additional Provider/Submitted IDs
At times, payers may require a Secondary ID or a SSN instead of a tax ID code. The Additional Provider IDs section allows the user to enter this information.
- Select the Payer
- Enter the ID
- Select the Type
- Checkmark EDI. The EDI column must be check marked for the ID to be on the claim.
Note: To send the Billing Provider Taxonomy Code enter the Taxonomy Code under the Taxonomy column and select the check mark under the EDI column. Coventry and Medicaid payers may require the Billing Provider Taxonomy Code.
