Use Rendering Provider as Rendering Provider Name and NPI

Some payers require the Rendering Provider's Name and NPI to be visible on a CMS-1500. This can be accomplished by creating a claim line item rule to instruct the system on when to include the rendering provider's name and NPI.

Workflow

Let's review how to add the rendering provider information using a claim line item rule!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Claim Line Item Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
  5. Update the Claim Type to Professional.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, under Behaviors, click Set Rendering Provider Name and NPI to:.
  8. Update the drop-down to Rendering Provider.
     
  9. Click Save to complete the process.
      

Box Number(s)

• UB-04: n/a
• CMS-1500: Box 24j - Rendering Provider

Helpful Hints

• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• To read more about updating the Rendering Provider information, see the Managing Rendering Providers article.
• To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.
• To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.