Claim Form Rule: Use Practice Name as Billing Provider Name

  • Updated

What claim change is needed?

Use Practice Name as Billing Provider Name.  There are times when Payers require the Practice Name or Group Name to be on the claim instead of the individual Billing Provider Name.  Within AveaOffice, the Practice Name and Billing Name are the same. There are times where Practice Names and Billing Names vary slightly and this claim rule should be used.

Box Number

UB-04: Box 1

CMS-1500: Box 33

Steps

  1. Navigate to Management Center > Claim Rules
  2. Click "Create Claim Form Rule".
  3. Select the Practice.
    mceclip2.png
  4. Name the claim rule.
    Screen_Shot_2021-05-21_at_3.57.42_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 - Name.Screen_Shot_2021-05-21_at_3.58.06_PM.png
  8. Then click Add.
  9. From the Select dropdown arrow, choose Practice Billing Provider Name.Screen_Shot_2021-05-21_at_3.58.25_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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