Rendering providers
The Rendering Provider screen shows the provider's full name, NPI or Group NPI, External ID, deactivation date, and current status.
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.
If a Provider Type is required, choose the appropriate option from the dropdown menu.
Select the appropriate option based on whether the provider is billing under their EIN or SSN.
If required, enter the State License number.
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, go to the Insurance Companies and select the payer to add the Claim Specific Rule "Box 24 Use Taxonomy code in Box 24J shaded in the claim form and EDI." This ensures the taxonomy code, along with the ZZ qualifier, is displayed in Box 24J of the claim form.
The External Reference # is a unique identifier assigned to a provider by another vendor when using an interface. It informs RXNT of the data the provider receives through the interface and ensures it is properly linked.
To display the provider's name in Boxes 12, 13, or 31, 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 be displayed in Box 31, or wish to use the secondary ID only, click the Folder Icon.
Click the "Send Rendering Provider Name in Box 31" checkbox. This option is particularly useful for sending the rendering provider's name in Box 31 for certain payers while excluding it for others
Click the "Use Secondary ID Only" checkbox to ensure that only the information from the secondary identifier is used for that specific payer.
Then, click Ok.
Additional providers
Click Providers, then Additional Providers. From here, you can add or search for an existing provider.
To add a new provider, click New Provider.
Check the checkbox next to the type of new provider you would like to add.
Fields marked with a red asterisk are required.
If the Taxonomy Code has been entered, it will appear in Box 33B of the claim form without the ZZ qualifier.
If the payer requires the ZZ qualifier, go to the Insurance Companies and select the payer to add the Claim Specific Rule "Show Provider Taxonomy code in Box 33B." This ensures the taxonomy code, along with the ZZ qualifier, is displayed in Box 33B of the claim form.
Provider Type Information
- Billing Providers list the providers whose services can be billed through the system for the practice.
- The Rendering Provider is intended to designate the provider who is performing the service.
- A Referring Provider is a physician who sends a patient to another doctor for specialty care or services.
- The Ordering Provider orders the patient's service, including labs, radiology, etc.
- A Supervising Provider is a provider overseeing the procedure. This Supervising Provider is in good standing and using their credentials for the NP, PA, etc.
- A Purchase Service Provider is any individual performing lab procedures at the practice or at an outside lab facility. The Payer requires this provider to be identified when selecting “yes” or “no” within the Transaction Code field.
- An Operating Physician performs an operative procedure in the Medical Center.
- An Attending Provider is the physician who has overall responsibility for the patient's medical care and treatments.
- An Assistant Surgeon helps surgeons with tasks such as making incisions, placing clamps, and closing surgical sites.
Still need help? Contact us!
Have a great idea? Tell us about it!