Use Facility or Practice NPI as Billing Provider NPI

This rule will instruct the system to use the Facility or Practice NPI as the billing provider NPI. 

Workflow

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

• 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 - NPI
     
     
  9. Next, click Add.
     
  10. To use the Facility NPI, update the dropdown to Facility NPI.
      
  11. To use the Practice NPI, select Practice NPI.
      
  12. To create multiple behaviors, repeat steps 7-10.
  13. Click Save to complete the process.
       

Box Number(s)

• UB-04: Box 56- Billing Provider NPI
• 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.