Claim Form Rule: Use Facility Name as Billing Provider Name

  • Updated

What claim change is needed?

Use Facility Name as Billing Provider Name.  There are times when Payers require the Facility or Group Name to be on the claim instead of the individual Billing Provider Name.  

Box Number

UB-04: Box 1

CMS-1500: Box 32

Steps

  1. Navigate to Management Center > Claim RulesScreen_Shot_2021-05-21_at_3.37.05_PM.png
  2. Click "Create Claim Form Rule".
  3. Select the Practice.
    mceclip2.png
  4. Name the claim rule.
    Screen_Shot_2021-05-21_at_3.38.29_PM.png
  5. Set Claim Type to Institutional or Professional depending upon service.
    mceclip1.png  Screen_Shot_2021-05-19_at_12.54.10_PM.png
  6. Set conditions for the claim rule to be met.
    Typically, this is a payer requirement so you'll select the appropriate payer type (i.e. Primary Behavioral Payer)
  7. Select the Available Behavior: Billing Provider - Address.
    Screen_Shot_2021-05-21_at_3.32.37_PM.png
  8. Then click Add.
  9. From the Select dropdown arrow, choose Facility Address.Screen_Shot_2021-05-21_at_3.33.08_PM.png
  10. At the bottom of the window, click the Create button.

Related Articles

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.

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