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Enable Incident-To Practitioner - Registry Setting

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Avatar PM > Billing > Electronic Billing > 837 Professional

'Y' enables the following:

  • 1 - enables the fields Is This An Incident-To Service?, and Incident-To Category For Coverage on the Service Fee/Cross Reference Maintenance form to allow you to specify a service as an incident-to service, and specify practitioner categories (for a service) that require an incident-to practitioner to be reported on the bill.

  • 2 - enables the Incident-To Practitioner field in the Edit Service Information, Edit Service Information (Charge Fee Access), Spreadsheet Edit Service Information, Client Charge Input, and Progress Notes forms to allow you to specify if there is an incident-to practitioner for a service.

  • 3 - modifies the following bills: 837P (Rendering Provider Name - 2310B/2420A segment), and HCFA-1500 (Rendering Provider - 24J segment) to report an incident-to practitioner instead of a rendering practitioner for incident-to services that are rendered by a practitioner whose category for coverage matches at least one incident-to category for coverage of the service.

'YL' enables the logic in 'Y' and, during liability distribution, validates the Practitioner Categories For Coverage for a benefit plan with the entry in the Incident-To Practitioner field. If a service does not contain an Incident-To Practitioner, the Rendering Practitioner will be used.

'YC' enables the logic in 'Y' as well as the following:

  • The Incident-To Practitioner field in the Practitioner Enrollment form.
  • The Incident-To Practitioner Credentials field in the Service Fee/Cross Reference Maintenance (Guarantor Definitions section), and the Incident-To Practitioner Daily Log forms.
    If a service does not contain an incident-to practitioner, the charge will be distributed to the payer, but it will be inhibited by billing and will display an error on the Electronic Billing report with the message, "No incident-to practitioner associated with this incident-to service."

 The incident-to practitioner only displays when the bill is configured to report a rendering practitioner.
 If a claim contains both incident-to, and non incident-to services, then the claim must be split into two separate claims, and the appropriate provider will populate the Rendering Provider Name (2310B) segment.

'N' disables the above fields, and disables the associated logic.