Billing Profile Carrier-Specific ID’s

In most cases, all you need to identify the provider on insurance claims is the provider’s NPI on the Provider Billing Profile you specified on your charge entry.

Sometimes, however, you may have an insurance payer that requires a different Rendering Provider NPI at the service detail level of the claim, or specification of a Supervising Provider, a unique Billing Provider (what used to be called “Supplier”) or one or more secondary ID’s. In SOS, you can cover these exceptional situations by creating Carrier Specific ID’s for any Provider Billing Profile that requires one:

  1. Open the Provider form.
  2. Click the Billing Profiles tab.
  3. Open the desired Billing Profile details form.
  4. Click the Carrier Specific ID’s tab.
  5. Click the New button.

Because these are configurations meant to apply to a specific Carrier, or even a specific Plan of a specific Carrier, the first thing you must do is to select the appropriate Carrier at the top of the form.

Next, if the configuration is not meant to apply to every Plan of the selected Carrier, then be sure to specify the desired Carrier Plan as well. Otherwise, leave the Carrier Plan field empty so that the configuration will be used for all the Carrier’s Plans.

Now look through the available fields, and enter values for any of the fields that need non-generic data. For example, sometimes Medicaid requires that you use the NPI of the billing agency rather than the NPI of the actual rendering provider for service detail lines of the claim. In that case you would enter the agency NPI in the middle of this form. That will override the provider’s normal NPI with the one you enter on this screen. If that is the only exception or addition you need, then you can leave all the other fields (other than the first two or three at the top) blank. Save the form and you are all set.

Another scenario might require that you use a different provider’s information for the rendering provider fields on the insurance claim. Again, some Medicaid payers might require that you complete the claim with the Medical Director’s information rather than that of the person who actually rendered the service. In that case, you can select the appropriate Billing Profile of the Medical Director in the Rendering Provider Billing Profile field. That instructs SOS to get any needed rendering provider data from the selected Medical Director’s Billing Profile rather than the current provider’s. Just make that one change on this form and leave the other fields below Carrier Plan empty.

Leave a Reply

Your email address will not be published.

You may use these HTML tags and attributes:

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

This site uses Akismet to reduce spam. Learn how your comment data is processed.