Managing Providers

After the initial Provider setup phase, you have the ability to update, change, and manage each Provider in WebPT Billing.

IN THIS ARTICLE

Locate Providers

  1. Navigate to the Admin menu and select Providers.
  2. You can search by Provider Code, Last Name, or First Name. You can also select the Include Inactive checkbox to view inactivated providers. Click Search
  3. Results display below numerically by Provider Code. You can filter your results by clicking the filter icon next to the column header. Reorder your results by clicking on the column header.  

  4. You can Export or Print this list by clicking the appropriate button in the bottom right-hand corner of the screen.


Updating Provider Information

  1. To update Provider information on the Providers page, double click on the Provider in the list displayed.

  2. To update the Provider Information, change the information in the fields displayed to update the information and click Save at the bottom of the screen once complete.

    1. Provider Description:  The provider’s full name is listed on their state license, followed by the specialty. This appears on the provider summary report, so it's important to ensure this field is accurate.
    2. Provider Type: The service level of the provider
      1. Billing Provider: A provider who is credentialed to bill claims (can be a cosigner).
      2. Treating Provider: A provider who requires a cosigner to bill claims (For example, this can be a PT who isn't credentialed with a specific payer and needs a cosigner, or an assistant).
      3. Student: A student completing their clinical hours.
      4. Non-clinical Staff: Typically given to practice admin, to have similar access as a provider. This is a legacy option for RevFlow EMR users.
    3. Primary Specialty: Primary care specialty of the provider. Choose the correct option based on the provider's credentials.
    4. Taxonomy Code: Standard taxonomy code based on provider specialty. This field goes on the claims and is required for billing.
    5. National Provider Identifier: Use the NPI validated on the NPPES website. This field is required for Billing and Treating Providers. If needed, use 123456789 as a placeholder.
    6. State License: The state license number validated on the state license lookup. This field is required for Billing Providers, For Treating Providers, you can use 9s as a placeholder.
    7. Alt Record ID: Provider ID number from the WebPT EMR. This will come over automatically when the provider imports from the WebPT EMR. Do not change this field.

Provider Claim Holds

Provider Claim Holds allow users to set up automatic Claim Delays based on provider credentialing. This is beneficial when the lack of credentialing or licensure will lead to a denial. Once the hold is inactivated, any associated charges will automatically be released from Claim Delay when the charge edits process runs again. 

To review more about Adding/Editing Provider Claim Holds, please click here.


Adding Billing Settings

Note: The Billing Settings card establishes certification for five government-based insurance companies: Medicare, Medicare Advantage, Medicaid, Medicare Railroad, US Department of Labor. 

Important: Until the credentials are added, all claims for these payers for the provider will be held on the Delayed Claims report automatically.

Additionally, if you would like specific commercial insurances for this provider to bill out under an individual provider number, you’ll need to create a Billing Setting and include the Insurance Code and Individual Number.

  1. To add provider credentials, click the  new button in the Billing Settings section of the provider’s page. 

  2. The credential settings drawer will open on the right side of the screen. Note: Use the settings drawer to build your credentialing rules for the payers and locations where the provider treats.

  3. Enter the required and desired information.

    1. Setting Name: Choose a name for the set of credentials. Each credential set must have a unique name.
    2. Status: Leave as active, otherwise, the credentials entered won’t apply and the claims will go on delayed claims for the five government payers.
    3. Tax ID Number: Leave blank.
    4. SSN/EIN: Identify if the location and the insurance should be billed with the provider's Social Security Number (SSN) or the Employer Identification Number (EIN). This typically is EIN.
    5. Individual Number: If the provider is credentialed with the payer, enter "Provider" in this field for all payers except US Department of Labor. For US Department of Labor, leave this field blank. Note: If you leave this field blank for Medicare, Medicaid, Medicare Advantage, or RailRoad, the claims will be put on Delayed Claims with the Therapist Not X Certified reason.
    6. Individual Qualifier: Leave as “none.”
    7. Group Number: If the provider is credentialed with the payer, enter "Provider" in this field for all payers except US Department of Labor. For US Department of Labor, you must enter the specific Group Number they provide. Note: If you leave this field blank, the claims will bill with the individual provider information only (in most cases this will result in claim rejections).
    8. Group Qualifier: Leave as “none."
  4. Next, complete the Location and Insurance information from the appropriate tabs. You can create credential sets for multiple treating locations. You will also choose whether you want to build credentials for insurance classes or individual insurance codes.

    1. Location: Use the checkboxes to select the clinic location(s) where the provider treats patients with this insurance class or insurance code. Use the Select All link to quickly select all locations.
    2. Insurance Class: Use the Search bar to locate the insurance class(es) for these credentials. If you want to add credentials for an Insurance Code, don't make a selection here. Use the Reset link in the lower-left to unselect the insurance classes.
    3. Insurance Code: Leave this field blank if you've chosen an insurance class. If you have left the insurance class blank, because you are adding specific credentials for a single commercial payer, enter the insurance code here. Use the Reset link in the lower-left to unselect the insurance codes.
  5. Once all of the required and desired information is complete, click Save in the top right corner of the drawer.

  6. When you save the credentials, the system automatically checks to ensure there are no conflicting credentials added for that provider. If there is a conflict, you’ll receive an alert. You’ll need to remove the conflicting combination to save the setting.

  7. Now the credentials will appear in the Billing Settings.

Important: Once the provider's credentials are added, any pended charged related to these five government payer classes (i.e. Medicare, Medicare Advantage, Medicaid, Medicare Railroad, or US Department of Labor) will be released automatically from the system. If you’ve added credentials for commercial insurances, you can release the manual hold you’ve placed on those charges from the Release Claim Delay page.


Editing Billing Settings 

  1. To edit existing Provider Credentials, click on the appropriate credential listed in the billing settings of the provider’s page.
  2. The credential settings drawer will open on the right side of the screen.
  3. At this point, you can make the necessary changes to the credentials and then click Save in the top right corner of the drawer. 
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