Use this article to bill a pre-licensed or non-credentialed provider's insurance claims under a credentialed colleague's NPI (National Provider Identifier), find providers whose billing details aren't set up, and fix sessions that can't be billed. This article is for admins and billers in Upheal practices that use insurance billing.
Note: Whether a practice should bill a provider's sessions under a colleague's NPI depends on each payer's credentialing rules. Check with your payers before using this setting.
What billing under a colleague's NPI does
Billing under a colleague's NPI lets a pre-licensed or non-credentialed provider's insurance claims go out under a credentialed colleague, so you don't have to fix each claim by hand. Payers reject claims when the rendering provider in box 24J (the rendering provider box on the CMS-1500 claim form) isn't credentialed with them.
When a provider is set to bill under a colleague's NPI, Upheal changes the following on every new claim for that provider:
Box 24J shows the colleague's name, NPI, and taxonomy code (the code that identifies a provider's specialty).
Box 33 (billing provider) doesn't change.
Billing under a colleague's NPI doesn't move any work away from the original provider. The provider who saw the client keeps the following:
Their sessions, notes, and claims. They can still edit their own claims.
Payments from the payer, which still land on the original provider's session.
Their own name and NPI on superbills.
Note: Billing under a colleague's NPI is a billing setting, not a supervision setting. The colleague doesn't need to be the provider's clinical supervisor, and the setting is separate from note co-signing.
Who can use this: Admins and billers who manage billing for the whole practice. Your practice must use Upheal insurance billing.
Setting a provider to bill under a colleague's NPI
To bill a provider's claims under a colleague's NPI, choose the colleague in the Rendering providers section of Billing settings. The colleague must be an active provider in your practice who has an NPI and taxonomy code on file and bills under their own NPI.
Go to Settings > Billing settings.
Scroll down to the Rendering providers section, and find the provider. To find someone quickly, search by name or NPI.
Click Edit on the provider's row (or Set up if the row shows Not set up), and a panel opens on the right with the provider's name at the top.
Under NPI and taxonomy, check the provider's NPI and Taxonomy code, and correct them if needed. The provider sees the same values on their own Clinical info page.
Under Bill claims under, click A colleague's NPI.
Under Provider, select the colleague. Only providers with an NPI and taxonomy code on file are listed.
Click Save changes, and you'll see the message "Changes saved."
Once you save, the provider's row in Rendering providers shows the colleague's name and NPI. Every claim created for that provider from now on uses the colleague in box 24J, including replacement claims and refiled claims created later.
Note: Billing under a colleague's NPI only applies to claims created after you save. Claims that already exist aren't changed. To fix an existing claim, change the rendering provider on that claim's service lines by hand.
Switching a provider back to their own NPI
To bill a provider's claims under their own NPI again, change the Bill claims under setting back to the provider's own NPI. Billing under their own NPI is the default for credentialed providers.
Go to Settings > Billing settings.
In the Rendering providers section, click Edit on the provider's row.
Under Bill claims under, click the option with the provider's first name, such as Sam's own NPI.
Make sure the provider's NPI and Taxonomy code are filled in under NPI and taxonomy.
Click Save changes, and you'll see the message "Changes saved."
New claims for the provider now use the provider's own name, NPI, and taxonomy code in box 24J. Existing claims aren't changed.