Rendering providers

Rendering providers are the individuals who personally perform the service or procedure being billed. Their information must appear on the claim to show who delivered the care, ensuring accurate documentation, billing, and reimbursement.

To manage your rendering providers, click the utilities icon in the top right corner.

Click Providers, then Rendering Providers.

The Rendering Provider screen shows the provider's full name, NPI or Group NPI, external ID, deactivation date, monthly claim count, and current status.

The Monthly Claim Count column shows the number of claims submitted and the remaining number for the month for providers with part-time or very part-time licenses.

Click the monthly claim count number for the specific provider to view the associated Encounter IDs, Claim IDs, and Claim Sent Dates.

To print the Monthly Claims Sent screen, click the PDF icon. To download it as a CSV file, click the CSV icon.

Rendering provider profile screen

The Rendering Provider Profile screen provides a centralized view of all essential provider details. It serves as a central location for managing and reviewing key provider information relevant to claims processing and provider configuration.

Ensure the correct NPI is selected based on whether the provider is billing under their individual NPI or group NPI.

Individual NPI: Used when the provider is billing as an individual practitioner. This links claims and services directly to the individual provider, which is necessary for personal credentialing, reporting, and reimbursement.
Group NPI: Used when the provider is billing as part of a group practice or organization. This allows claims to be submitted under the group’s NPI, which is important for billing as a collective entity and for coordinating payments to the group.

If a Provider Type is required, select the appropriate option from the dropdown menu. Provider Types may include O, Z, or S:

O – Typically represents an “Other” entity type, such as an organization that doesn’t fit standard categories (e.g., trusts, estates, or other non-traditional entities).
Z – Often indicates a special classification or unique type of entity, such as a foreign entity or a designation used by a tax authority.
S – Usually represents a sole proprietorship.

These classifications help distinguish between different types of entities for reporting, billing, and tax purposes.

Select the appropriate option based on whether the provider is billing under their EIN or SSN.

EIN (Employer Identification Number): Used when the provider is billing as a business entity, such as a group practice, clinic, or corporation. This allows payments and tax reporting to be processed under the business entity rather than an individual.
SSN (Social Security Number): Used when the provider is billing as an individual. This is typically required for sole proprietors or independent practitioners who are personally responsible for reporting income and taxes.

If required, enter the State License number. The state license number is issued by the provider’s state licensing board and verifies that you are legally authorized to practice in their profession. It is used when a payer, credentialing body, or regulatory agency requires verification of the provider’s licensure. Entering the correct license number ensures compliance with state regulations, prevents claim denials, and supports accurate provider credentialing and billing.

If required, enter the Taxonomy Code. If the payer does not require a ZZ qualifier, you can enter the taxonomy in this field only. The taxonomy code will be included in the EDI but will not be displayed on the actual claim form.

If the payer requires the ZZ qualifier, navigate to the Insurance Companies screen and select the appropriate payer. Add the Claim Specific Rule: "Box 24: Use Taxonomy Code in Box 24J shaded in the claim form and EDI," and then click Save to apply the changes. This ensures that the provider’s taxonomy code, along with the ZZ qualifier, is properly displayed in Box 24J of the claim form, meeting the payer’s requirements for both electronic and paper claim submissions.

If required, enter the Provider Commercial Number. The provider commercial number is used when a payer or commercial insurance company requires a unique identifier for billing purposes. It is typically needed when the provider participates in a commercial insurance network and must be recognized under a specific provider ID for claims submission.

If you have enrolled in Eligibility, make sure to click the Enable Eligibility checkbox. Once enabled, enter the NPI number of the provider or entity that has been enrolled in the Eligibility NPI field. Verify that the NPI number is correct to ensure accurate eligibility checks and avoid errors when verifying patient coverage.

The Service Type indicates the provider’s claim service category, which determines the number of claims they are allowed to submit for billing purposes. This helps ensure accurate billing and compliance with claim submission limits. The available options are:

Full-Time: Providers with this status can submit an unlimited number of claims. This is typically assigned to providers with a standard, full workload.
Part-Time: Providers with this status are limited to submitting up to 150 claims per month. This is suitable for providers who work reduced hours or have a lighter caseload.
Very Part-Time: Providers with this status are limited to submitting up to 50 claims per month, usually assigned to providers who work minimal hours or provide only occasional services.

The Entity Name field is editable only if Practice is selected as the Entity type. When Practice is chosen, you can enter the name of the practice in the Entity Name field. This allows you to clearly identify the practice as the billing or service entity, which is important for claims submission, reporting, and recordkeeping. For example, if a clinic called “Sunrise Family Medicine” is providing services, and Practice is selected as the entity type, you would enter Sunrise Family Medicine in the Entity Name field so that it appears correctly on claims and patient records.

The External Reference number is a unique identifier assigned to a provider by another vendor when using an interface. It allows RXNT to recognize the provider’s data received through the interface and ensures it is accurately linked to the correct provider record.

To display the provider’s name in Boxes 12, 13, or 31 on the 1500 claim form, simply check the corresponding box.

The Rendering Provider Secondary Identifier lets you provide information you may not typically send to a payer. For example, a doctor might normally bill with their individual NPI, but if a specific payer wants them to use their group NPI, they can add that information here. The information listed in the Secondary Identifier field will go out on the claim form when that specific Payer is billed.

If you’ve added a secondary identifier and want the corresponding provider name to appear in Box 31, or if you prefer to use only the secondary ID for a specific payer, click the folder icon to open the settings.

Click the Send Rendering Provider Name in Box 31 checkbox to include the rendering provider’s name in Box 31 for payers that require it, while allowing you to exclude it for those that do not. If needed, select the Use Secondary ID Only checkbox to ensure that only the secondary identifier is used for that specific payer. When finished, click OK to save your changes.

You can enter the additional information on this screen; however, we recommend completing and editing this information on the previous screen, where you have full access to make changes. This screen is primarily used to select these specific options, rather than to enter or modify detailed information.

Additional providers

Additional providers refer to any providers involved in a patient’s care other than the rendering provider. This may include billing providers, referring providers, ordering providers, supervising providers, or any provider whose information is required on a claim or record to support medical necessity, authorization, or coordination of care.

To access and manage additional providers, click the Utilities icon.

Click Providers, then select Additional Providers. To create a new provider, click New Provider.

Check the box next to the type of provider you want to add. For example, if the additional provider is a Billing Provider, select the Billing Provider checkbox. This ensures the new provider is correctly classified and appears in the appropriate sections for billing, claims, reporting, and other system functions.

Provider type information

Billing Provider – The provider whose services can be billed through the system for the practice.
Rendering Provider – The provider who is actually performing the service.
Referring Provider – A physician who sends a patient to another doctor for specialty care or services.
Ordering Provider – The provider who orders the patient’s services, such as labs, radiology, and other diagnostic tests.
Supervising Provider – A provider overseeing a procedure who is in good standing and whose credentials support the NP, PA, or other clinical staff.
Purchase Service Provider – A provider performing lab procedures either within the practice or at an external lab. Payers require this provider to be identified when selecting “yes” or “no” in the Transaction Code field.
Operating Physician – The physician performing an operative procedure within the medical center.
Attending Provider – The physician responsible for the patient’s overall medical care and treatment plan.
Scheduling Provider – The provider who appears on the encounter and represents the charge but does not appear on the claim. Use this option when you need to associate a provider with a visit for reporting purposes without billing under that provider.
Assistant Surgeon – A provider who assists the primary surgeon by performing tasks such as making incisions, placing clamps, and closing surgical sites.

Add provider profile screen

Select Provider or Practice from the Entity dropdown menu.

If you have selected Provider, enter the provider’s First and Last Name in the required fields.

If you have selected Practice, enter the practice name in the Entity Name field.

Enter the address details in the required fields.

Ensure the correct NPI is selected based on whether the provider is billing under their individual NPI or group NPI.

Individual NPI: Used when the provider is billing as an individual practitioner. This links claims and services directly to the individual provider, which is necessary for personal credentialing, reporting, and reimbursement.
Group NPI: Used when the provider is billing as part of a group practice or organization. This allows claims to be submitted under the group’s NPI, which is important for billing as a collective entity and for coordinating payments to the group.

Select the appropriate option based on whether the provider is billing under their EIN or SSN.

EIN (Employer Identification Number): Used when the provider is billing as a business entity, such as a group practice, clinic, or corporation. This allows payments and tax reporting to be processed under the business entity rather than an individual.
SSN (Social Security Number): Used when the provider is billing as an individual. This is typically required for sole proprietors or independent practitioners who are personally responsible for reporting income and taxes.

If the provider has been issued a UPIN (Unique Physician Identification Number) and is required to submit it on claims, enter the details in the UPIN # field. For instance, if you are resubmitting or adjusting a claim from before NPI requirements were implemented, the payer may require the UPIN to match the provider information on the original claim. In this case, the UPIN must be entered to ensure proper claim processing and alignment with historical records.

If required, enter the Provider Commercial Number. The Provider Commercial Number is used when a payer or commercial insurance company requires a unique identifier for billing purposes. It is typically needed when the provider participates in a commercial insurance network and must be recognized under a specific provider ID for claims submission.

The Communication Preference section is only visible when selecting Billing Provider as the additional provider. If you need to add additional communication details for the billing provider, select Telephone from the Communication Preference dropdown menu and enter the phone number in the designated field. You may add up to three communication preferences, allowing you to include multiple contact phone numbers as needed.

Select the Use Pay To Address option if you need to include a P.O. Box as the billing address. Enabling this setting allows you to enter and designate the P.O. Box specifically for payment correspondence, ensuring that all payments are routed to the correct location. After enabling this option, choose the appropriate Entity from the dropdown menu and enter the full address details.

The Atypical Provider checkbox is only visible when selecting Billing Provider as the additional provider. An atypical provider is a healthcare-related professional or organization that does not meet the criteria for receiving a National Provider Identifier (NPI). Examples may include transportation services, home and community-based service providers, or non-medical support agencies. When this option is selected, the NPI and Group NPI fields become optional. If the NPI fields are left blank, no NPI information will be included on the claim.

The Secondary Identifier lets you provide information you may not typically send to a payer. For example, a doctor might normally bill with their individual NPI, but if a specific payer wants them to use their group NPI, they can add that information here. The information listed in the Secondary Identifier field will go out on the claim form when that specific payer is billed.

If you have added a secondary identifier and want to use it exclusively for a specific payer, click the Folder icon to open the settings.

Then select the Use Secondary ID Only checkbox to ensure only the secondary identifier is applied for that payer. When you're finished, click OK to save your changes.

You can enter the additional information on this screen; however, we recommend completing and editing this information on the previous screen, where you have full access to make changes. This screen is primarily used to select this specific option, rather than to enter or modify detailed information.

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Providers Setup