Rendering Provider for NGS Medicare

Jilda13 · Post by **Jilda13** » Mon Jan 30, 2012 4:24 pm

We are a billing service with 10 providers - each with separate practice. With invaluable support of MedTech our transition to Version 17 went smoothly. However, this week when I sent a claim with the referring provider the system also assigns a Rendering Provider for no reason. Relay health is bouncing all claims with Reject Code: 09 G1 and RCF report saying "09- Invalid Billing Prov. Ref ID Qual."I have similar situation with other providers and have no problems with them. Just this one provider. What is causing this problem that just started? Can anyone help me.
Thanks. Jilda

Post by **Gavin Walker** » Mon Jan 30, 2012 4:41 pm

Jilda, you are too kind!

Try going to Configure -> Receivers in Revenue Management and edit the receiver you are using. Make sure the box Suppress Legacy is checked and click Save.

In Medisoft there is always a Rendering Provider. That is the provider associated with the Transaction. Judging by your error message, I would guess an old legacy provider id and qualifier are being sent on the electronic claim.

Jilda13 · Post by **Jilda13** » Mon Jan 30, 2012 5:37 pm

Thanks Gavin for your prompt reply. But I hate to tell you that when I went into RM-Configure - Receivers - I have Relay Health only. Under there Medical ID's - Qualifier/ID is blank. This is same with all the other practices that I have. Checked the suppress button as you suggested. Still when I entered a new claim with referring provider only it is still saying Rendering Provider as well as the Referring Provider on the claim. I never had this problem before until this week. Jilda

Post by **Gavin Walker** » Mon Jan 30, 2012 7:43 pm

Look in the Practice IDs and Provider IDs grids. Find the record corresponding to your payer and make sure all provider id qualifiers and legacy IDs are deleted out. If there is no reason for a record to exist for this insurance company, consider deleting it. Do the same thing for your "ALL" grid entry. Also, scan the list for any duplicate entries for your insurance carrier. Duplicates can definitely throw things off and should be deleted. Look for any other records that could match such as insurance class records and deal with those as well. While you are editing each record, make sure NPI and Tax ID are entered on each one.

Jilda13 · Post by **Jilda13** » Tue Jan 31, 2012 2:43 pm

Many thanks. After three days of agony the problem is finally resolved. For this particular provider (and some others as well) claims are filed under either TX ID and SS. When I finally tried to edit the provider I noticed that the one for Medicare is sending claims as a group rather than individual thus causing the "Rendering Provider" problem. Once I switched it to "individual" everything was OK. Many thanks for all your help.