Managing claim forms for providers

You can edit the information that appears on certain claim forms for a provider.

To edit form settings for a provider

1.   From the File menu, point to Providers, and then click Provider Table.

The Provider Table window appears.

2.   Select a provider.

3.   Click Forms.

The Edit Form Settings dialog box appears.

4.    Select a Form Number (claim format).

5.   Set up the following options for the selected claim form:

·        Billing Provider Name – Type the name to use as the billing provider on claims. This can be a person or business entity (such as a corporation or an organization).

·        Billing Provider Type - Select whether the name entered for the Billing Provider Name is an Individual or a Group (business entity).

·        Billing Provider License # - Type the state license number of the billing provider for claims.

·        Billing Provider NPI -  Select which ID to use as the billing provider's NPI on claims: Medicaid, Medicare, Delta Dental, Blue Cross/Blue Shield, UPIN, License, Tax ID, NPI, Blue Cross, Blue Shield, Taxonomy, or Champus.

·        Tax ID - Type the federal tax ID of the billing provider for claims. Also, select whether this ID is a SSN or EIN. Only the last four digits of the Social Security number are visible until you click in the field.

·        Special ID # - Select which ID to use on claims when an additional number for specialists is required by an insurance company: Medicaid, Medicare, Delta Dental, Blue Cross/Blue Shield, UPIN, License, Tax ID, NPI, Blue Cross, Blue Shield, Taxonomy, Champus, or Loc. Medicaid. This ID appears in Box 58 on ADA claim form 2006, 2012; Box 54 on ADA claim form 2002; Box 59 Admin only section on ADA claim form 2000.

·        CDANet # (Canada only) - Select which ID to use on Canadian claims. In addition to the options that are available for the Special ID # (from the US version), there is a "CDA Location #" option.

·        Provider ID # - Select which ID to use in certain fields on claims depending on the claim format: Medicaid, Medicare, Delta Dental, Blue Cross/Blue Shield, UPIN, License, Tax ID, NPI, Blue Cross, Blue Shield, Taxonomy, Champus, or Loc. Medicaid. The select ID appears on claims according to the following situations:

·        As the Provider ID # in box 44 on ADA claim forms (version 2000).

·        As the Provider ID # in box 49 on ADA claim forms (version 2002).

·        As the NPI in box 49 on ADA claim forms (version 2007-2008).

·        As the PIN # in box 33 on CMS-1500 claim forms.

·        As the Billing Provider NPI on Emdeon e-claims.

·        Servicing Provider Name - Type the name of the treating provider.

·        Servicing Provider License # - Type the license number of the treating provider.

·        Servicing Provider NPI - Select what ID to use as the treating provider's NPI: Medicaid, Medicare, Delta Dental, Blue Cross/Blue Shield, UPIN, License, Tax ID, NPI, Blue Cross, or Champus, or Loc. Medicaid.

·        Default to printed claims - Select this check box if an insurance profile is set up to be sent claims electronically by default, and you want to override that setting for the provider so that claims are printed. This setting affects only this provider, not all providers linked to this form type.

·        Billing Provider First Name - Type the first name to use as the billing provider on electronic claims.

·        Billing Provider Last Name - Type the last name to use as the billing provider on electronic claims.

·        Servicing Provider First Name - Type the first name to use as the treating provider for electronic claims.

·        Servicing Provider Last Name - Type the last name to use as the treating provider for electronic claims.

·        Submitter ID Overrides - To override the settings for the provider and the selected form number, click this button to open the Override Submitter ID Settings dialog, and then select Submitter ID or Provider for the Billing Name, Tax ID #, Address, and NPI. Close the Override Submitter ID Settings dialog box when you are finished.

6.   Repeat steps 4 - 5 for any other form settings you want to change for the provider.

 

Need more help?

You can visit our website, contact OMSVision Customer Support, or suggest a new feature or improvement on User Voice.