Manage Rendering Providers

Rendering Providers—the individual who rendered care—are configured in Avea at the Practice-level. They can be tied to one or more facilities. When the Rendering Provider is set as the billing provider for the service, their information will be in Box 2 on the UB-04 and Box 33 on the CMS 1500. Additionally, you can configure Rendering Providers to appear on Box 19 on the CMS 1500 to satisfy the AHCCCS requirement (Arizona-based clients only).

Managing Rendering Providers is often necessary when providers change their location or leave an organization. In Avea, this change is managed with scheduled change sets.

Creating a Rendering Provider

Let's review how to create a Rendering Provider. 

1. Navigate to Practice Admin and click on the Rendering Providers tab.
2. Click on Create Rendering Provider.
3. Enter the fields below for this provider:

   Can Bill Insurance as Billing Provider: Toggle Yes/No. If the rendering provider is set as a billing provider, their information will be in Box 2 on the UB-04 and Box 33 on the CMS 1500. NPI Number: Required Tax Identification Number: required if Can Bill Insurance as Billing Provider is set to Yes. Tax Identification Number Type: Employer Identification Number (EIN) or Social Security Number (SSN) First Name: Required Last Name: Required Credentials/Degrees State License Number Provider UPIN Number Provider Commercial Number Location Number Provider Taxonomy Is Active: If the doctor's profile should only be available to be used for claims billing as of a specific date, change the Is Active toggle to No. Is Medicaid Registerable: Allows Rendering Providers to be set as Additional Providers on professional services and populate Box 19 of the CMS 1500. This is currently only required by AHCCCS (Arizona-based clients only).  Can Be Assigned to Authorizations: Leave this toggle on to allow the Rendering Provider to be selected from the Rendering Provider list when creating a Utilization plan for the patient. Toggle off this field to prevent the Rendering Provider from being added to Utilization Plans.

4. Click Create.

Add A Scheduled Change Set

Optional: If you need to set a specific date for when this provider can be used for billing claims, like the provider's start date, you can create a scheduled change set. 

1. Click on the Provider's name (under Practice Admin > Rendering Providers).
2. Click to Create Scheduled Change Set.
3. Enter the Effective Date that the doctor's profile should be available for claim billing.
4. Click Create.
5. Click the Edit icon next to the new column with the chosen effective date.
6. Change the Is Active toggle to Yes.
   
7. Click Save. 

Add Provider Modifier 

Use the following steps to add a license-level modifier to the provider that needs to appear on the claim form. The Provider Modifier field doesn't appear until the Rendering Provider has been created and can be added to the baseline or as part of a scheduled change set. 

1. Open the Rendering Provider from the Practice Admin.
2. You can edit the Baseline to make the change effective now and in the past, or create a Scheduled Change Set to set an effective date for the modifier addition.
3. Add the Rendering Provider Modifier and click Save. 
4. To pull (or omit) the modifier on claims, please create a Claim Line Item Rule by following these instructions. 

Reference Provider in Each Facility

Once the provider is created, you'll need to reference the provider at each facility they treat at. 

1. Navigate to Practice Admin and open the Facilities tab.
2. Click on the facility Name where the provider will render services.
3. Open the Facility Rendering Providers tab.
4. Click Add Rendering Provider Reference.
5. Select the Rendering Provider from the drop-down and click Add.

Now the new rendering provider profile is available for new claim billing as of the effective date in the change set. Their profile will not be available to be selected for claims billed with dates of service prior to the effective date set in the scheduled change set. If you would like their profile to be available for all time, leave the Is Active toggle to Yes when creating the Rendering Provider and skip the Scheduled Change Set steps. 

Deactivate a Rendering Provider

To prevent a rendering provider from being sent on claim forms, you can deactivate the provider by adding a scheduled change set to inactivate the provider on a specific date. This ensures the provider profile remains active for claim corrections on past dates of service but cannot be used going forward.

1. Go to Practice Admin and select the Rendering Providers tab.
2. Click on the name of the Rendering Provider you wish to deactivate.
3. Click on Create Scheduled Change Set.
4. Enter the effective date (this should be one day after the last day the doctor's profile should be used to bill claims).
   
5. Click Save.
6. Click the Edit icon next to the new column with the chosen effective date.
7. Change the Is Active toggle to No.
   
8. Click Save.

Remove from Facility (Optional)

Deactivating the rendering provider at the practice-level will also deactivate the provider reference at the facility-level. If you would like to see the provider's name disappear from the facility-level list:

1. Go to Practice Admin and open the Facilities tab.
2. Click on the name of the facility where the provider's profile was referenced. 
3. Select the Facility Rendering Providers tab.
4. Click on the name of the Rendering Provider you want to remove.
5. Click on Create Scheduled Change Set.
   
6. Enter the effective date (this should the same date as the other change set e.g., one day after the last day the doctor's profile can be used to bill claims.
7. Click Create.
8. Click the pencil icon next to the new column with the chosen effective date. 
9. Change the Is Active toggle to No.
   
10. Click Save.

If the doctor provided services at more than one facility, repeat the above steps for the other facilities.

Now the doctor's profile is inactive for new claim billing from the effective date onward. However, their profile will remain active for claim corrections for past dates of service.