Claim Form Rule: Use Facility NPI as Billing Provider NPI

  • Updated

What claim change is needed?

Use Facility NPI as Billing Provider NPI.  There are times when Payers require the Facility or Group NPI to be on the claim instead of the individual Billing Provider NPI; if this is your scenario, keep in mind you will need to setup a claim form rule for each payer this billing scenario applies. 

Box Number

UB-04: Box 56

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_2.15.37_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.
    1. Typically, this is a payer requirement so you'll select the appropriate payer type (i.e. Primary Behavioral Payer; refer to the Claim Rules article for definitions if needed).
  7. Select the Available Behavior: Billing Provider - NPI.
    Screen_Shot_2021-05-21_at_2.22.38_PM.png
  8. Then click Add.
  9. From the Select dropdown arrow, choose Facility NPI.Screen_Shot_2021-05-21_at_2.28.10_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.

Was this article helpful?

0 out of 0 found this helpful

Comments

0 comments

Please sign in to leave a comment.