Rendering Provider

Rendering Provider Editor

1. Rendering Provider entries are used by the claims system to determine which Facilities and Staff/Providers should be reported to Payors on outbound 837 and HCFA files.
   
2. A Rendering provider entry specifies the relationship between a Payor, a Renderer (Employee or Provider Site), and a Facility, the Identifiers to use for that relationship, and the date range during which the relationship is valid.
   
3. If these relationships are missing or inactive as of a date of service on a claim, that claim may be validated out of the batch.
   
4. The two types of relationships are {Payor, Employee, Facility} and {Payor, Provider Site, Facility}.
   

       2. A selection in the Renderer dropdown will auto-fill the Renderer Last Name and First Name fields, but those values can be edited in case they need to different when sending claims to the specified Payor.

       3. A selection in the Facility Address dropdown will auto-fill the Street Address, Zip Code, City, and State fields, but those values can be edited in case they need to be different when sending claims to the specified Payor.

       4. The Primary ID field is the only required identifier (which is usually the NPI of the individual or facility).

Rendering Provider Payors

1.            Selecting from the previously entered Renderers in the Rendering Provider dropdown will display all of the Payor relationships that have been entered for that Renderer.
   

2. Choosing the Facility option in the Action dropdown in the Payors section will display all the Rendering provider relationships that have been entered for that Renderer/Payor combination.
   
3. The checkboxes allow you to review Archived, Deleted, and Expired Facility entries in addition to the default view of active entries (for historical purposes).

Facilities

1.        Depending upon the options checked above in the Payors section, the Facilities listing will show all Renderer/Payor/Facility relationships.
   

2.             Actions can be performed on each of the Facility entries:     
   

3.        The Edit action will display all of the details associated with the selected entry in the top Rendering Provider Editor section and allows each of the fields to be updated.       
   

4.  Note: Changing a Payor, Renderer, or Facility when in Edit mode will effectively replace the previous entry and should be checked for overlap with another entry that may already have that combination.
   
5. The Hold action will place an entry in a temporary hold status and cause the Rendering entry to not be seen by the billing system.
   
6. The Archive action will place an entry in an archived status and cause the Rendering entry to not be seen by the billing system.
   
7. The Delete action will mark an entry as deleted and cause the Rendering entry to not be seen by the billing system.
   
8. The Duplicate action will display all of the details associated with the selected entry in the top Rendering Provider Editor section and allows each of the fields to be updated.
   

1. This option is meant to help the user avoid repetitive data entry when configuring a new Payor/Renderer/Facility relationship.
   
2.  Generally, when using this option, either the Payor or Facility are most often changed. This is because the Primary ID and date values are usually the same for a Renderer regardless of which Facility or Payor their information is being reported to.
   
3.   Note: Using this option and clicking Submit without changing any information will create a duplicate, which will cause duplication in the billing system when reporting information on the claim.