Managing Provider Billing Profiles

Prior to SOS G5, it was sometimes necessary to create multiple entries in the Provider List to handle different billing requirements or practice compensation policies. SOS G5 simplifies these situations by allowing each Provider (again, the Provider is an actual person) to have any number of Billing Profiles. Each of a Provider’s Billing Profiles details how the Provider will be presented on insurance claims and statements, but also how the provider will be paid by the practice for her work. Here is a quick example: in many group practices a Provider may bill and be compensated differently for patients whom she has brought into the practice personally, as opposed to patients who came to the practice as a result of the practice’s advertising or web site. In SOS you can add, view, and modify Billing Profiles by opening a Provider and selecting the Billing Profiles tab.

Whenever you create a new Provider, the system will automatically create a default Billing Profile with a matching code. In the example above, the Provider Code (prefix) is CG, and the automatically created Billing Profile Code (suffix) is also CG. If you would rather change the profile code to something else, you are free to do so by changing the value of Provider-Suffix Code in the first field on the Billing Profile form.

The fields on this form should look familiar to you, as they match fields on the main Provider form. In fact, SOS copies the values for each of these fields from the Provider form. In most cases, there will be at most a handful of fields that you might want to change from the defaults — usually just the Payroll Multiplier or perhaps the name to appear on insurance claims or one or more secondary ID’s.

Note, however, that there are some tabs on this form as well:

Billing Profile Fees
Carrier Specific ID’s

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