Add Rendering Provider Modifiers

A Rendering Provider Modifier can be added through the Rendering Provider profile. 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 a claim should meet before the rule will apply.
     
  7. Next, under Behaviors, click Add Modifier.
  8. Update the drop-down to Require and Write to Claim.
     
  9. 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.