Use Practice Billing Entity as Rendering Provider Name and NPI

Some payers require the Practice Billing Entity information 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 Practice Billing Entity information.

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 Practice Billing Entity.
     
  9. Click Save to complete the process.
      

Box Number(s)

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

Helpful Hints

• To read more about updating the Practice Billing Entity information, see the Insurance Billing 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.