Use Facility Name or Practice Name as Billing Provider Name

This rule will instruct the system to use the Facility or Practice Name as the billing provider instead of the individual Billing Provider Name.

Workflow

Let's review how to create a claim rule to use the Facility or Group Name as the billing provider!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Claim Form  Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
  5. Update the Claim Type to Institutional or Professional.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, click on the Behaviors dropdown.
  8. Select Billing Provider - Name.
     
     
  9. Next, click Add.
     
  10. To use the Facility Name, update the dropdown to Facility Name.
       
  11. To use the Practice Billing Provider Name, select Practice Billing Provider Name.
      
  12. To create multiple behaviors, repeat steps 7-10.
  13. Click Save to complete the process.
       

Box Number(s)

• UB-04: Box 1- Billing Address, Phone, and Provider. 
• CMS-1500: Box 33- Billing Provider Information

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 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.