Create and Manage Rendering Providers

Rendering providers are configured in the RCM at the Practice Level and can be tied to one or more facilities. Rendering provider profiles include essential information about the provider, such as their NPI, Tax ID, credentials/degrees, etc.

User Permissions

Only admin-level user profiles can create and manage rendering provider profiles in the RCM. For more information on user permissions, click here.

Create Rendering Providers

Each rendering provider created must be referenced at the facility level. These references specify which provider(s) can be included on a claim as the rendering provider. Providers that render treatments at multiple facilities must be referenced first before they can be included on the claim.

1. Navigate to the Practice Admin and click Rendering Providers.
   
2. Next, click Create Rendering Provider.
   
3. Enter the provider's NPI and Tax ID in their respective fields.
   
4. Next, enter their First Name and Last Name.
   
5. When applicable, enter the provider's credentials as they should appear on the claim form.
6. Update the Rendering Provider Credential drop-down include a rendering provider modifier on the claim. Note: that this claim line item rule will need to be in place before the modifier will display on a claim form. For information on configuring rendering provider credentials, click here.
   
7. When appropriate, include the provider's taxonomy and toggle on the following settings when:
   1. Is Medicaid Registratable: Allows the provider to be set as an Additional Provider in Box 19 of the CMS-1500.
   2. Can Be Assigned To Authorizations: Allows the provider to be assigned to individual U/R plans for billing.
   3. Can Bill Insurance as Billing Provider: Allows the provider to be used as the billing provider on the claim.
      
8. Include any of the additional fields when appropriate.
9. Click Create to complete the creation process.
   
10. Once the provider has been created, click the Facilities tab.
11. Select the facility name to open its profile.
    
12. Then click Facility Rendering Providers.
    
13. Next, click Add Rendering Provider Reference.
    
14. Select the desired rendering provider from the dropdown and click Add to complete the process.
    

Manage Rendering Providers

When you set the Rendering Provider as the billing provider for the service, their details will show up in Box 2 on the UB-04 and Box 33 on the CMS 1500. You can also configure Rendering Providers to appear in Box 19 on the CMS 1500 to meet the AHCCCS requirement (only for Arizona-based clients). Managing Rendering Providers is often needed when providers update their location or leave an organization. In the RCM, you can manage this change with scheduled change sets.

Note: Providers deactivated at the practice level will also have to be deactivated at the facility level.

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  1. Navigate to the Practice Admin and click Rendering Providers.
     
  2. Locate the desired rendering provider and click on their name.
     
  3. In the provider's profile, click Create Scheduled Change Set.
     
  4. Enter the effective date and click Save.
     
  5. Next, click the pencil icon next to the effective date displayed.
     
  6. Edit the desired fields and click Save to complete the process.