Add Institutional Secondary Provider ID

This rule allows the addition of a Secondary Provider ID to institutional claims. You can add or find the necessary information within the Rendering Provider profile. The following IDs can be used as secondary provider IDs on UB-04 claims:

• Provider Location Number
• Provider Commercial Number
• Provider Taxonomy Code
• Rendering Provider NPI
• State License Number
• UPIN

Workflow

Let's review how to create a claim rule to add a Secondary Provider ID to institutional claims.

• 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.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, click on the Behaviors dropdown.
  8. Select Institutional Secondary Provider ID.
     
  9. Next, click Add.
     
  10. Update the dropdown to one of the following selections:
      1. Omit to leave the box blank. 
      2. Require and Write Location Number to include the provider's location number.
      3. Require and Write Provider Commercial Number to include the provider's commercial number.
      4. Require and Write Provider Taxonomy to include the provider's taxonomy. 
      5. Require and Write Rendering Provider NPI to include the provider's NPI. 
      6. Require and Write State License Number to include the provider's state license number.
      7. Require and Write UPIN to include the provider's UPIN. 
         
  11. To create multiple behaviors, repeat steps 7-10.
  12. Click Save to complete the process.
       

Box Number(s)

• UB-04: Box 76 - Attending Provider Name and Identifiers
• CMS-1500: N/A

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.