Difference between Practitioner Category, Discipline, Practitioner Credentials, and Practitioner Categories for Coverage
This article explains the differences between Practitioner Category, Discipline, Practitioner Credentials, and Practitioner Categories for Coverage and indicates how each item is used.
| Item | Description | Where used |
|---|---|---|
| Practitioner Category |
Typically, the Practitioner Category is a provider's credentials. The Practitioner Category prints in Box 31 of the CMS 1500 if sorted by practitioner and the Practitioner Category is set to ‘Yes’ on the Guarantor/Program Billing Defaults - Paper CMS-1500 section for the appropriate template. To print the practitioner's credentials in Box 31 of the CMS 1500, select a HCFA-1500-NPI Version (Sort by Practitioner) when generating the bill. |
In Service Fee/Cross Reference Maintenance if there are different fees, CPT/HCPCs codes, or modifiers based on the provider’s credentials |
| Discipline |
The discipline is a practitioner's specialty area or field of study, such as Medical Doctor, Nursing, Pharmacist, or Social Work. Enable the 'Restrict Practitioner Based upon Discipline' registry setting to use logic that checks that at least one discipline is common to the practitioner and service code being filed. If attempting to schedule or provide a service for a practitioner that does not have the appropriate discipline, then the system will prevent the practitioner from providing or scheduling the service. As well the Service Codes must have Disciplines associated in the Service Codes form. |
In Service Codes to restrict service codes to only the selected discipline |
| Practitioner Credentials |
Practitioner credentials appear after the practitioner's electronic signature on the TIFF image and Chart View. Practitioners can have multiple credentials. It is a recommended best practice to have the dictionary code exactly match the credential value. Practitioner Enrollment (Categories/Taxonomy) |
For clinical auditing and documentation requirements |
| Practitioner Categories for Coverage |
Practitioner Categories for Coverage are groups of practitioners covered by Insurance carriers to provide services. |
In Benefit Plans to associate benefit plans to specific practitioner categories In Find New Appointment to filter by Practitioner Categories for Coverage In Managed Care Authorizations to specify the required staff type In Advanced Billing Rule Definition as a rule definition option |