Provider Claim Settings
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The provider's claim settings are used to format electronic claim submissions and paper claim printing. Claim settings are configured for each provider and can be general (affecting all payers) or more specific (override for a specific payer or location).
Navigate to Claim Settings
- Click Settings > Providers. The Find Provider window opens.
Tip: When there are multiple providers listed, use the Look For search bar to enter all or part of a keyword for the provider. Then, click Find Now.
- Find the provider then double click to open it. The Edit Provider window opens.
- Click the Claim Settings tab.
- Select the appropriate claim settings for the provider:
- NPI: Select how the provider is credentialed with payers to send claims in the drop-down menu.
Note: The Group NPI will auto-populate from the Practice Information and the Individual NPI will auto-populate from the General tab.
- If Bill with Group and Individual NPI is selected, but the provider's claims need to be sent with a different Group NPI, click to select "Override Group NPI?". Then, enter the Override Group NPI.
- Tax ID: Select how the provider is credentialed with payers to send claims in the drop-down menu.
Note: The EIN will auto-populate from the Practice Information and the SSN will auto-populate from the General tab.
- Select Bill with EIN if the provider is credentialed with payers to send claims using an Employer Identification Number (EIN) assigned by the IRS to the practice. This applies to any business entity including a Corporation, LLC, LLP, Partnership, or other taxable business entity.
- If the provider's claims need to be sent with a different EIN, click to select "Override EIN?". Then, enter the EIN Override.
- Select Bill with SSN if the provider is credentialed with payers to send claims using the provider's Social Security Number (SSN). This might be the case if the practice is a sole proprietorship and has not been assigned an EIN from the IRS.
- Click to select "Enable Pay-To Address For Professional Claims" and enter the Name and Address if the pay-to address differs from the practice's (e.g., a P.O. Box or Lockbox).
- Override Claim Settings: Add, edit, or remove any insurance companies or service locations that have exceptions to the general claim settings.
- Click Save (the Confirmation pop-up appears then click Yes to confirm) or click the Provider Performance Report tab to select report settings.