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Practitioner Numbers By Guarantor and Program - PM

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Assign provider numbers to practitioners.

Avatar PM > System Maintenance > System Definition > Practitioner Numbers By Guarantor and Program

  • Provider numbers are used in billing.

  • This information will populate associated fields in myAvatar forms, and can be edited when it populates.

    • If there are multiple entries filed in this form, the record where the service date falls between the effective and expiration dates is used in billing files.

    • When selecting a previously filed guarantor and program combination, the most current information will populate the associated fields for the guarantor and program combination.

  • Different entries for the same guarantor and program:

    • Only one field value can be entered for a combination of: guarantor, program, financial class, and treatment setting.

Steps to Add Practitioner Numbers

  1. In the Practitioner field, enter the practitioner name/ID and select a value from the Results list.

  2. In the Financial Class field, select the financial class.
    Guarantors that are associated with the financial class display in the Guarantor ID field.

  3. In the Guarantor ID field, select the guarantors to associate with the practitioner.

  4. In the Treatment Setting Selection field, select the treatment settings.
    Programs that are associated with the treatment setting display in the Program field.

  5. In the Program field, select the programs.

  6. In the Effective Date field, enter the date when the practitioner number becomes effective.

  7. In the Expiration Date field, enter the date when the practitioner number expires.

  8. In the NPI Number field, enter the National Provider Identifier number for the practitioner. This is used by all billing processes (837I/837P/HCFA-1500/UB-04) where an NPI is required. The NPI number is validated against the Luhn algorithm to ensure it is valid.

    • 837 Professional Usage (Loop-Segment-Field):
      2310A-NM1-09 - Referring Provider NPI
      2310B-NM1-09 - Rendering Provider NPI
      2310D-NM1-09 (5010 Only) - Supervising Provider NPI
      2420A-NM1-09 - Rendering Provider NPI (line level)
      2420F-NM1-09 - Referring Provider NPI (line level)

    • 837 Institutional Usage (Loop-Segment-Field):
      2310A-NM1-09 - Attending Provider NPI
      2310C-NM1-09 - Other Operating Physician NPI
      2310D-NM1-09 (5010 Only) - Rendering Provider NPI
      2420C-NM1-09 - Rendering Provider NPI (line level)

    • 837 Dental Usage (Loop-Segment-Field):
      2310B-NM1-09 - Rendering Provider NPI
      2420A-NM1-09 - Rendering Provider NPI (line level)

    • UB-04 Usage:
      Form Locators 76 - Attending Provider NPI
      Form Locators 77 - Operating Physician Provider NPI
      Form Locators 78 - Other Provider NPI

    • HCFA-1500:
      Item Number 24J - Rendering Provider NPI

  9. In the Taxonomy Code field, select the appropriate code.

    • 837 Professional Usage (Loop-Segment-Field):
      2310B-PRV-03 - Rendering Provider Taxonomy Code
      2420A-PRV-03 - Rendering Provider Taxonomy Code (line level)

    • 837 Institutional Usage (Loop-Segment-Field):
      2310A-PRV-03 - Attending Provider Taxonomy Code

    • 837 Dental Usage (Loop-Segment-Field):
      2310B-PRV-03 - Rendering Provider Taxonomy Code
      2420A-PRV-03 - Rendering Provider Taxonomy Code  (line level)

    • HCFA-1500:
      Item Numbers 24I and 24J - Rendering Provider Other ID Type and Number (The taxonomy code is designated by the provider in order to identify his/her provider type, classification, and/or area of specialization.)

  10. In the Secondary Identification Qualifier field, enter the appropriate code.

    • 837 Professional Usage (Loop-Segment-Field): 
      2310A-REF-01 - Referring Provider Secondary ID Type
      2310B-REF-01 - Rendering Provider Secondary ID Type
      2330E-REF-01 - Other Payer Service Facility Location Secondary ID Type
      2420A-REF-01 - Rendering Provider Secondary ID Type (line level)
      2420F-REF-01 - Referring Provider Secondary ID Type (line level)

    • 837 Institutional Usage (Loop-Segment-Field):
      2310A-REF-01 - Attending Provider Secondary ID Type
      2310C-REF-01 - Other Operating Physician Secondary ID Type
      2420C-REF-01 - Rendering Provider Secondary ID Type (line level)

    • 837 Dental Usage (Loop-Segment-Field):
      2310B-REF-01 - Rendering Provider Secondary ID Type
      2330E-REF-01 - Other Payer Supervising Provider Secondary ID Type
      2420A-REF-01 - Rendering Provider Secondary ID Type (line level)
      2420C-REF-01 - Supervising Provider Secondary ID Type (line level)

    • UB-04 Usage:
      Form Locator 76 - Attending Provider Secondary ID Qualifier
      Form Locator 77 - Operating Physician Secondary ID Qualifier
      Form Locator 78 - Other Physician Secondary ID Qualifier

    • HCFA-1500
      Item Number 24I - Rendering Provider Other ID Type

  11. In the Secondary Identification # field, enter the appropriate code:

    • 837 Professional Usage (Loop-Segment-Field):
      2310A-REF-02 - Referring Provider Secondary ID
      2310B-REF-02 - Rendering Provider Secondary ID
      2330E-REF-02 - Other Payer Service Facility Location Secondary ID
      2420A-REF-02 - Rendering Provider Secondary ID (line level)
      2420F-REF-02 - Referring Provider Secondary ID (line level)

    • 837 Institutional Usage (Loop-Segment-Field):
      2310A-REF-02 - Attending Provider Secondary ID
      2310C-REF-02 - Other Operating Physician Secondary ID
      2420C-REF-02 - Rendering Provider Secondary ID (line level)

    • 837 Dental Usage (Loop-Segment-Field):
      2310B-REF-02 - Rendering Provider Secondary ID
      2330E-REF-02 - Other Payer Supervising Provider Secondary ID
      2420A-REF-02 - Rendering Provider Secondary ID (line level)
      2420C-REF-02 - Supervising Provider Secondary ID (line level)

    • UB-04 Usage:
      Form Locator 76 - Attending Provider Secondary ID
      Form Locator 77 - Operating Physician Secondary ID
      Form Locator 78 - Other Physician Secondary ID

    • HCFA-1500
      Item Number 24J - Rendering Provider Other ID

  12. In the Supervising Practitioner field, enter the name or ID of the supervising practitioner and select a value from the results.
     Supervising Practitioner is used on the 837P in Loop 2310D. It is also used in Loop 2310B if the registry setting Enable Supervising Practitioner Based on Rendering Practitioner (2310B) is used. Supervising Practitioner for HCFA 1500 NPI will be used if the field Print Supervising Practitioner in Form Locator 31 For Sorted HCFA-1500-NPI Version Only is set to Yes in the Paper CMS-1500 section of the Guarantor/Program Billing Defaults form.

  13. In the Comments/Notes field, enter any remarks.

  14. Click Submit.

SQL Table

  • SYSTEM.table_prac_num_guar_prog