Managing Providers

SOS Providers are actual people who provide services to patients or clients. (Note that the SOS system also has Billing Providers, which are legal/financial entities that bill for services and are associated with bank accounts to which fees are paid.)

To add a new Provider, or to view, modify, or (if not already in use) delete a Provider, expand Common Lookups on the navigation bar on the left side of the main screen, then select Providers.

The Providers list will appear. From here, use the New icon on the toolbar at the top of the screen to create a new Provider entry. Alternatively, you also can use the <CTRL><N> keyboard shortcut, or right-click and select “New” from the pop-up menu. If you just want to open a Provider already in the list to view or change the details, simply double-click that row on the list view. Below, you can see the Main tab of the Provider form. Notice that there are several other tabs (Billing Profiles, Provider Fees, Carrier Specific ID’s, and User Defined Fields) that are addressed in other articles.

The very first field on this form is the Provider-Prefix Code. This is the shorthand code that is used to indicate a particular provider when scheduling appointments or entering progress notes. You can enter up to three characters for this value. In SOS, the provider’s initials are often used as the Provider-Prefix Code, but any combination of between one and three characters can be used, as long as it is unique among your providers. An example would be “ABC”.

The Provider-Prefix code also serves as the first part of the Provider code to be used on a Charge transaction, that is, the record of a fee being charged for a service. Charge transactions are the records that are used to create billing. Unlike the provider designation for an appointment or progress note, however, the Charge entry also needs additional information, stored in one of the Provider’s Billing Profiles, that is specific to just billing actions. Each billing profile is designated by another code of up to three characters. That means you when entering a Charge in the daysheet you will be selecting a provider that has a two part code, for example “ABC-MC” or “JS-1”. The first part is the Provider-Prefix Code from this field. The second part of the two-part code comes from another code that designates which of the provider’s Billing Profiles should be used when billing this service.

If you have licensed the Appointment Scheduler module, you can use the Encounter Form field to specify which of your Encounter Form configurations should be used when printing encounter forms for patients to document visits. Encounter forms contain the patient’s identifying information including diagnosis, a notation of the service(s) provided, the provider’s information, and often some detail about insurance coverage, fee, and payment.

Provider Communications Panel

Add as many phone numbers, addresses, and emails as you like for this provider in the Communications panel. It works exactly as it does in the Patient form. If you need additional explanation, please see the Patient Communications article.

Defaults Section

The Defaults Section of the Provider form contains a set of fields that are also found on the Provider Billing Profiles form. Whenever you create a new Billing Profile for a provider, SOS copies all the values you specify here to the new Billing Profile. You can then change or add information as appropriate before saving the new Billing Profile. Among these Default fields are the following:

  • The Billing Provider is the name of the legal/financial entity used by this provider for claim filing, patient statements, and for depositing payments. In most cases this is official organization name, often a corporation of some sort. In SOS you can have more than one of these entities, so here you will indicate the appropriate one for this provider.
  • If desired, you can specify a Category to be used for data analysis. For example, a large behavioral health organization might want to compare utilization patterns among salaried staff, capitated providers, and fee-for service providers. Adding a code here for each of these types of providers would allow this type of analysis.
  • Provider Type allows you to create fee schedules that apply to all providers of the designated type (although individual exceptions are still permitted). If you have many providers with different credentials (for example: psychiatrists, psychologists, clinical social workers, nurse practitioners, and mental health counselors), then you should assign each provider to an appropriate Type. Assignment of types also can be handy for analytic purposes.
  • Taxonomy Code indicates the provider’s professional training and specialty area and must be specified on claims. One source for a current list of Taxonomy Codes is the National Uniform Claim Committee.
  • The Payroll Multiplier is used by some organizations to calculate the portion of the billed fee or payments the provider will receive as compensation for her work. For example, if a provider’s pay is based on 50% of the fees collected during the pay period, you should enter “50” in this field. Note that other types of payroll that are based on specific services provided rather than payments received may be better handled by setting a “cost” figure for each service/provider combination in Provider Fee Schedules.

There are several tabs at the top of the Provider form. For information about each of the following, click the link to go to the separate article about it:

One thought on “Managing Providers

Leave a Reply

Your email address will not be published. Required fields are marked *

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.