Add Rendering Provider Modifiers

A Rendering Provider Modifier can be added through the rendering provider's profile and configured in the Organization Admin. However, a claim rule is needed to instruct the system to write the rendering provider's modifier to the claim.

Workflow

Let's review how to add a modifier to a claim with a claim rule!

1. Navigate to Management Center > Claim Rules.
   
    
2. Click Create Claim Line Item 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 that a claim should meet before the rule will apply.
   
7. Under the Behaviors section, click Rendering Provider Modifier.
8. Update the dropdown to one of the following options:
   1. Omit to create the claim without the rendering provider modifier. 
   2. Require and Write to Claim to always include the rendering provider modifier.
   3. Write to Claim if Present to only include the rendering provider modifier when present in the provider's profile.
      
9. To create multiple behaviors, repeat steps 7-10.
10. Click Save to complete the process.
    

Box Number(s)

• UB-04: Box 44 - HCPCS/Rate/HIPPS code
• CMS-1500: Box 24j - Rendering Provider

Helpful Hints

• To read more about updating the Rendering Provider information, see the Managing Rendering Providers article.
• 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.