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 and 8.
10. Click Save to complete the process.
    

Box Number(s)

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

Frequently Asked Questions and Helpful Hints

Let's review some helpful hints and some more commonly asked questions!

Frequently Asked Questions

• The best way to determine if a scheduled change set is appropriate is to gauge how many claims will be affected. For example, if you want the rule to apply to previously billed claims as well as new claims going forward, create the rule without a scheduled change set. 
  
  However, if you want the rule to apply only to newly created claims, use a scheduled change set to instruct the system to look only for claims with dates of service on or after the set date. For more information on scheduled change sets, click here.
• If you are creating the rule to apply to previously billed claims, navigate to the Patient > Treatment Episode > Claims > Review Corrections section and click Check For Corrections. If corrections are generated, follow the process outlined here to complete the process. If no claims are flagged for rejection, click here to troubleshoot the rule why the rule may not be applying.

Helpful Hints

If one of your conditions is payer-based, select any applicable Current Sequence options 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.