Rendering Provider Issues

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bel915
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Joined: Fri Aug 03, 2012 11:09 am

Rendering Provider Issues

Post by bel915 » Thu Oct 25, 2012 8:04 am

Good morning,

So i just found out today that my claims have been received with the wrong rendering provider to the insurance companies. They have been receiving them with the main doctor of the group. When we post the charges, we do add the rendering doctor on the charge line.

What are we doing wrong?

Thanks for your help.


Belinda

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Gavin Walker
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Re: Rendering Provider Issues

Post by Gavin Walker » Thu Oct 25, 2012 8:59 am

More than likely you have the provider's group NPI setup on the individual provider's PINs grid record. Instead the individual NPI always goes to the individual provider's PINs grid. If you need the billing provider to be the group, then select the option file claims as group and setup the group NPI on the practice PINs grid.
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

bel915
Posts: 22
Joined: Fri Aug 03, 2012 11:09 am

Re: Rendering Provider Issues

Post by bel915 » Thu Oct 25, 2012 9:26 am

THANKS FOR YOUR REPLY.

I checked the settings on individual's PIN grid, and it does have the individual NPI correct and also have it set up as file claim as group. I also checked the Practice PIN's grid and there i also have the practice set as group and non-person. Although i didnt have the NPI group number on the NPI box of the practice grid... could that have been the cause of this?

I did notice though that I have on the individual provider list on the tab "reference", i have set up on 'provider class' the group npi??
Is that suppose to stay there?

I upgraded to version 16 a few months ago and I didnt have this issue before. :(

Hope to hear from you soon!

Thanks

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Gavin Walker
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Re: Rendering Provider Issues

Post by Gavin Walker » Thu Oct 25, 2012 9:39 am

You can ignore the items on the Reference tab. Those are old provider ids from prior versions of Medisoft that aren't used anymore.

The conversion process to convert the old PINs grid to the new one on version 16 does not do a very good job. We usually find it is easier to delete them all and setup the provider ids again. To do this, press CTRL-Del to delete all rows out of the PINs grid. Then setup your "All" record for how you typically do your billing. Add any override rows for individual insurance exceptions. Setup the individual NPI on all provider ID records and indicate whether to file claims as group or individual as necessary. Fill out all information on all records that you setup.

Then do the same thing for your practice ids grid except setup group NPI on all these records.

You will also want to double check your facility ids and referring provider ids if you have any of those.

bel915
Posts: 22
Joined: Fri Aug 03, 2012 11:09 am

Re: Rendering Provider Issues

Post by bel915 » Thu Oct 25, 2012 11:05 am

I did exactly as you told me and for some odd reason, it is still submitting the claims with the incorrect rendering provider?
I deleted the provider id's and created them again, although it didnt let me delete the main doctor since its used on the assigned provider on the case tab.

Any other suggestions you might recommend me?

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Gavin Walker
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Re: Rendering Provider Issues

Post by Gavin Walker » Fri Oct 26, 2012 8:47 am

In Transaction Entry, make sure the attending provider on each charge is set to the rendering provider. Add the attending provider to the charge grid if necessary. If that still doesn't get it, are these electronic or paper claims?

bel915
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Joined: Fri Aug 03, 2012 11:09 am

Re: Rendering Provider Issues

Post by bel915 » Fri Oct 26, 2012 3:41 pm

They are electronic. We are adding the rendering provider on the transaction entry.

But I finally figured out what we were doing wrong, when we create claims, we were NOT choosing the attending provider, it was creating the claims under the assigned provider.

I appreciate and time for answering my questions.

Have a great and restful weekend!

Belinda

ABChiro
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Re: Rendering Provider Issues

Post by ABChiro » Wed Jan 23, 2013 9:36 pm

I am having the same problem with my V14 and changing the provider to the attending provider during claim transactions did not fix my issue.

It only seems to be using the incorrect information when I am entering tranactions for a patient who was previously beeing seen by the other provider. In other words if the new provider starts with the patient, the problem doesn't exist.

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Gavin Walker
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Re: Rendering Provider Issues

Post by Gavin Walker » Thu Jan 24, 2013 9:27 am

On the Case, make sure the Assigned Provider is selected before entering new transactions. The assigned provider on the case will default as the Attending Provider on each Charge Transaction that is entered under that case. If the transactions are already entered, add attending provider to the charge transaction grid and then change the provider on the charge transaction line. The billing provider on the claim will either be the assigned provider or the attending provider depending the option that is selected when the claim is created. If the wrong option was selected when the claim was created, then delete the claim and recreate it with the correct option.

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