Electronic Billing 837 Professional - Rendering Provider Name (Loop 2310B)
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Admission (Outpatient)
- Client Charge Input
- Client Ledger
- Crystal Report Viewer
- Diagnosis
- Dynamic Form - Admission - Client
- Dynamic Form - Edit Service Fee Definition
- Electronic Billing
- Financial Eligibility
- Ok - Cancel Dialog
- Practitioner Enrollment
- Service Codes
- Practitioner Numbers By Guarantor And Program
- Admission
Scenario 1: 837 Professional bill - Select Type Of Information To Include In Rendering Provider Name (2310B) = Rendering Practitioner for the Majority of Services in the 'Guarantor Program Billing Defaults'
Specific Setup:
- Guarantors/Payors:
- An existing guarantor is identified. Note the guarantor name / id.
- Guarantor/Program Billing Defaults:
- 837 Professional section:
- Set the 'Select Type Of Information To Include In Rendering Provider Name (2310B)' field to the 'Rendering Practitioner for the Majority of Services' option.
- Practitioner Enrollment:
- Two practitioners are identified, or two new practitioners are created with NPI number. Note the practitioner id/name.
- Admission:
- A new client is admitted in the outpatient program. Note the client id / name.
- Financial Eligibility:
- The guarantor identified above is assigned to the client as the primary guarantor.
- Diagnosis:
- An admission diagnosis record is created for the client.
- Service Codes:
- Two existing professional service codes are identified. Note the service code.
- Service Fee/Cross Reference Maintenance:
- Make sure the fee definition is created for the service code and CPT Code is assigned to the service fee definition.
- Client Charge Input: The test will require one practitioner to provide more services than the other practitioner.
- Enter desired number of services for practitioner 1, using service code 1. Note the dates of service.
- Enter desired number of services for practitioner 2, using service code 2, different dates of service, and providing at least one more service that practitioner 1 provided.
- Client Ledger:
- All the services rendered to the client are distributed correctly to the guarantor assigned to the client.
- Close Charges:
- All the services rendered to the client are closed.
- Create Interim Billing Batch:
- An interim billing batch is created to include client, guarantor and services rendered to the client.
Steps
- Open an 'Electronic Billing' form.
- Compile an 837 professional bill.
- Verify the bill compiles successfully.
- Review the dump file.
- Verify the dump file includes rendering practitioner with the highest service count in the 2310B loop (NM1*82 at claim level) of the bill.
- Close the form.
Scenario 2: 837 Professional bill - Select Type Of Information To Include In Rendering Provider Name (2310B) = 'Supervising Practitioner for the Majority of Services' in the 'Guarantor Program Billing Defaults'
Specific Setup:
- Guarantors/Payors:
- An existing guarantor is identified. Note the guarantor name / id.
- Guarantor/Program Billing Defaults:
- 837 Professional section:
- Set the 'Select Type Of Information To Include In Rendering Provider Name (2310B)' field to the 'Rendering Practitioner for the Majority of Services' option.
- Practitioner Enrollment:
- Two practitioner are identified, or two new practitioners are created with NPI number to be used as a rendering practitioner while rendering services to the client. Note the practitioner id / name.
- Two practitioner are identified, or two new practitioners are created with NPI number to be used as a supervising practitioner of the rendering practitioner. Note the practitioner id/name.
- Practitioner Numbers by Guarantor and Program:
- A supervising practitioner is selected for each rendering practitioner.
- Admission:
- A new client is admitted in the outpatient program. Note the client id / name.
- Financial Eligibility:
- The guarantor identified above is assigned to the client as the primary guarantor.
- Diagnosis:
- An admission diagnosis record is created for the client.
- Service Codes:
- Two existing professional service codes are identified. Note the service code.
- Service Fee/Cross Reference Maintenance:
- Make sure the fee definition is created for the service code and CPT Code is assigned to the service fee definition.
- Client Charge Input: The test will require one practitioner to provide more services that the other practitioner.
- Enter desired number of services for practitioner 1, using service code 1. Note the dates of service.
- Enter desired number of services for practitioner 2, using service code 2, different dates of service, and providing at least one more service that practitioner 1 provided.
- Client Ledger:
- All the services rendered to the client are distributed correctly to the guarantor assigned to the client.
- Close Charges:
- All the services rendered to the client are closed.
Steps
- Open an 'Electronic Billing' form.
- Compile an 837 professional bill.
- Verify the bill compiles successfully.
- Review the dump file.
- Verify the dump file includes correct supervising practitioner with the highest service count in the 2310B loop (NM1*82 at claim level) of the bill.
- Close the form.
Scenario 3: 837 Professional - When the service counts are equal for all rendering practitioners - the practitioner with the earliest service date as a rendering practitioner in loop 2310B
Specific Setup:
- Guarantors/Payors:
- An existing guarantor is identified. Note the guarantor name / id.
- Guarantor/Program Billing Defaults:
- 837 Professional section:
- Set the 'Select Type Of Information To Include In Rendering Provider Name (2310B)' field to the 'Rendering Practitioner for the Majority of Services' option.
- Practitioner Enrollment:
- Two practitioners are identified, or two new practitioners are created with NPI number. Note the practitioner id/name.
- Admission:
- A new client is admitted in the outpatient program. Note the client id / name.
- Financial Eligibility:
- The guarantor identified above is assigned to the client as the primary guarantor.
- Diagnosis:
- An admission diagnosis record is created for the client.
- Service Codes:
- Two existing professional service codes are identified. Note the service code.
- Service Fee/Cross Reference Maintenance:
- Make sure the fee definition is created for the service code and CPT Code is assigned to the service fee definition.
- Client Charge Input: The test will require same count of the services are rendered by each practitioner.
- Enter desired number of services for practitioner 1, using service code 1. Note the dates of service.
- Enter desired number of services for practitioner 2, using service code 2, different dates of service. Note the id/name of the practitioner used as a rendering practitioner.
- Client Ledger:
- All the services rendered to the client are distributed correctly to the guarantor assigned to the client.
- Close Charges:
- All the services rendered to the client are closed.
- Create Interim Billing Batch:
- An interim billing batch is created to include client, guarantor and services rendered to the client.
Steps
- Open an 'Electronic Billing' form.
- Compile an 837 professional bill.
- Verify the bill compiles successfully.
- Review the dump file.
- Verify the dump file includes the practitioner with the earliest service date in the 2310B loop (NM1*82 at claim level) of the bill.
- Close the form.
Scenario 4: 837 Institutional - Validating rendering or attending practitioner in the loop 2310 A of the bill.
Specific Setup:
- Guarantors/Payors:
- An existing guarantor is identified. Note the guarantor name / id.
- Guarantor/Program Billing Defaults:
- 837 Institutional section:
- Set the ‘Specify Rendering Practitioner As Attending Practitioner In Loop 2310A (Attending Physician Name)’ field to 'Y'.
- Practitioner Enrollment:
- Four practitioners are identified, or new practitioners are created with NPI number to be used as an admitting, attending, and rendering practitioner. Note the practitioner id/name.
- Admission:
- A new client is admitted in the inpatient program. Note the client id / name.
- Financial Eligibility:
- The guarantor identified above is assigned to the client as the primary guarantor.
- Diagnosis:
- An admission diagnosis record is created for the client.
- Service Codes:
- Two existing professional service codes are identified. Note the service code.
- Service Fee/Cross Reference Maintenance:
- Make sure the fee definition is created for the service code and CPT Code is assigned to the service fee definition.
- Client Charge Input: Client Charge Input: The test will require one practitioner to provide more services that the other practitioner.
- Enter desired number of services for practitioner 1, using service code 1. Note the dates of service.
- Enter desired number of services for practitioner 2, using service code 2, different dates of service, and providing at least one more service that practitioner 1 provided.
- Client Ledger:
- All the services rendered to the client are distributed correctly to the guarantor assigned to the client.
- Close Charges:
- All the services rendered to the client are closed.
- Create Interim Billing Batch:
- An interim billing batch is created to include client, guarantor and services rendered to the client.
Steps
- Open an 'Electronic Billing' form.
- Compile an 837 professional bill.
- Verify the bill compiles successfully.
- Review the dump file.
- Verify the dump file includes attending practitioner in the 2310A loop (NM1*71 at claim level) of the bill.
- Close the form.
- Open the ' Guarantor / Program Billing Defaults' form.
- Set the ‘Specify Rendering Practitioner As Attending Practitioner In Loop 2310A (Attending Physician Name)’ field to 'Y'.
- Open the 'Practitioner Numbers By Guarantor And Program' form.
- Create an entry of rendering practitioner, Guarantor and Program.
- Open an 'Electronic Billing' form.
- Compile an 837 professional bill.
- Verify the bill compiles successfully.
- Review the dump file.
- Verify the dump file includes rendering practitioner as an attending practitioner in the 2310A loop (NM1*71 at claim level) of the bill.
- Close the file.
- Close the form.
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Topics
• 837 Institutional
• 837 Professional
• NX
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