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We just started billing for a new provider (urgent care facility). the facility is the billing provider as well and we are assigning the actual physician as the rendering provider. So basically when a cms 1500 is printed box J has the rendering physicians NPI and the the facility is listed as the facility and the billing provider. The claims are getting rejected by emdeon and they say it is because the rendering providers information isn't in box 31.. I'm so confused! Box 31 is a signature line and no where can I see that there is a spot to put the rendering physicians actual name and address. We have a second provider that we bill for and we do it this exact same way and the claims go through fine. I am pulling my hair out as emdeon keeps telling me that I have to put the actual name of the rendering provider in box 31 for this particular facility/provider. I keep telling them I can' put the rendering provider info in box 31 but they are ignoring that. Am I wrong???? Is the name of the rendering provider supposed to be in box 31 on that signature line and if so....how do I get it there. Or...is there a different spot that the rendering providers name is supposed to print. I just can't figure out why it works for one provider and not another.....emdeon is frustrating me.....any help would be great. Thanks

On Medisoft v16 or higher, go into the provider IDs grid and edit the "ALL" record and select "File Claim as Group". Then go to Practice IDs and make sure an "ALL" record is setup there with group information and all other information filled out. Any excepts for particular payers can be added to the grids. Records that don't need to be in the provider IDs grid should be deleted.

Also, it sounds like you are filing print image claims. You should be filing ANSI 5010 claims if you are on Medisoft v17 or higher. You can work with a Medisoft re-seller who can set this up for Emdeon. We presently charge $150 to setup the first practice for this service. We have setup several on Emdeon before.

We were doing it right...the people in emdeon were the ones that was confused. they had our mapping wrong and for some reason they kept saying to put the rendering physicians name in box 31.....when in reality it was them that needed to get our mapping corrected. We finally was able to talk to someone that knew what they were talking about. It is impossible to put the rendering physicians name and address in box 31....like they kept saying to do....ugh...it can be so frustrating sometimes!

I am glad you got it figured out. For future reference you CAN send the rending provider name in box 31 in Medisoft on print image claims.

V17.
I am having the same PO Box issue. We recently opened another clinic and want all our mail to our new PO box. Still getting a lot of mail to old PO Box and sometimes to physical address.

All providers have physical address in their tabs.

Practice info has the physical address under practice (boy howdy dont change THAT to a PO BOX!) and PO Box under pay to tab. We file as a group, putting the rendering provider in the transactions.

Anything I am missing here?
Thank you and thank you for this forum.

That sounds right. Statement Pay to is for your patient statements. You probably need to update agreements with your contracted payers because they will probably go by the address they have on file.

Hi, its me again. Well it turns out all is not well in the rendering physician category..still. We just recently started billing for an urgent care clinic. We are having claims denied, saying the rendering provider information is missing. When we go to emdeon and look at the claim info they submitted the correct npi is showing (and if a paper claim is printed the correct npi is showing in box j)...however if you look at the rendering physican name and and address that is on the emdeon claim information...it is inserting the first word in the clinic name ( in the frst name field) and the clinics address...bascially their telling us the rendering physicians name is incorrect...which is true. Emdeon is telling us we need to fix it on our end. I'm not sure what I can do differently. The physicians name is in the providers list with his correct npi and file as group is marked and tax id is from practice. His npi is being inserted correcty but for some reason it isn't sending over his name/nfo....instead it is sendig the name of the clinic...I am so frustrated I could pull my hair out. any thoughts or ideas as to what we need to do differently?

I recommend switching over to ANSI format claims to avoid all these print-image to ANSI mapping issues.

well I guess I don't know what you mean. I assumed Medisoft was mapped with the most updated mapping. I guess I am un educated when it comes to ANSI mapping. We have had our medisoft software since August and are new to it. I thought it was already ANSI compliant.

Medisoft is ANSI 5010 compliant IF you are submitting claims in ANSI 5010 format. You say you are submitting print image claims. So your clearinghouse must convert the print image to ANSI 5010 and be compliant for you. There are 33 locators in a paper claim that must be mapped to thousands of fields in an ANSI claim. Some of it must be generated. This is what clearinghouses do, but depending on the claim it can be tricky.

I suggested submitting in ANSI 5010 format to eliminate the back and forth regarding what is mapped from where on the print image.

Well...I guess I'm confused because I don't know what you mean by print image. We submit all of our claims electronic via a text file to emdeon. I realize there are lots of mapping that has to be done but I assumed it was being transmitted in ANSI 5010 format because that is the latest format being used and we were told Med 17 was complient. I know you can submit claims from revenue manager, but and I wondered if you had to submit if from there to be in ANSI format...but we cant get it to work...I had it set up but it doesn't bring up the dialog box to save the file as a text file so I have no way to transit it to our clearing house. I have been sending claims from the main program because it is the only way that has worked smooth.....so i the mapping issue on emdeon's side when it comes to the rendering physicians name not being inserted correctly?

Yes, I think you are starting to see. If you edit the file that is generated from Medisoft that you send to Emdeon, using Notepad, you should see that the data in the file is arranged pretty much like it is printed on a CMS-1500 form. Look at the locator that Emdeon says to put the rendering provider info and make sure the data is there. Box 31 is probably where they want the provider's name and box 24J is where they probably want the individual NPI number. If everything looks in order, then Emdeon should be able to map it to an ANSI format for you.

If you upload ANSI 5010 claims, there is no "mapping" step which can eliminate a lot of errors when sending claims because every field is defined and there is no reason to do a mapping. To do ANSI claims you have to use Revenue Management. To send ANSI claims to Emdeon, you have to configure Rev. Mgmt. Unless you know what you are doing, it will probably take hours for you to figure it out. I suggest you work with a Medisoft reseller who can configure Rev. Mgmt. They will be able to get you setup quickly. McKesson will not help you with Rev. Mgmt. setup unless it is for RelayHealth clearinghouse. We presently charge $150 to setup the first practice on Rev. Mgmt. for claims only. $200 if you also need it setup for electronic remittance posting.

No it does not insert a name where box 31 typically would be (the signature line on the printed cms, correct?).... The npi is being put in the right spots, but for some reason medisoft isnt putting the name in box 31 is there a way to map medisoft to do this so we don't have to use revenue manager...or is that the only place. Revinue manager is so confusig to me. If we have you set up the first practice will you teach us how to do it so we can set up additional practices? We currently bill for 3 different providers. We are a new billing company and hopefully we will grow and obviously this is something we need to do eventually. I really do appreciate your help. The crazy thing is we have not had problms with any payers except PEHP.

Edit the insurance carrier for this claim and then go to the Options and Codes tab. In Physician Signature on File be sure Print Name is selected. Next edit your provider record in Medisoft and make sure the Signature on File box is checked.

If that doesn't work, tell me how you generate your print image claims. Are you using CMS11, CMSFILE, or do you have a custom report where you select Export to File rather than one of the printer options?

If you are using Medisoft v16 or higher, then you should go into the provider IDs grid and edit the "ALL" record then you can select "File Claim as Group". After this, you can go to Practice IDs and make sure an "ALL" record is set up there with group information and all other information filled out. Now excepts for particular payers can be added to the grids. Records that don't need to be in the provider IDs grid should be deleted. I think this will help you to solve your problem, if then also the same problem persists then you can take help of technical support.


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