Provider Billing Settings

In this article, we review some key rules that govern how the Provider Billing Setting page functions. To review how to Add or Edit Billing settings, please navigate to Managing Providers.

It’s important to note, that aside from the five government payers listed below, the majority of non-government insurance billing behavior is governed by the insurance class. It’s crucial to select the correct insurance class when creating/mapping your insurances so that your electronic claims bill out correctly. 

General Provider Billing Settings Information

You can override the system’s default settings if you drop the claim to paper 

This works for items such as: 

  • Tax ID Number which populates Box 25
  • Individual Number which populates Box 24j 
  • Group Number which populates Box 33b
Non-Government Payers
  • Individual Claims: Adding information into the Individual Number field but leaving the Group Number field blank causes the claims for the selected insurance classes/codes to bill as individual claims.
  • Group Claims: Adding information into the Group Number field but leaving the Individual Number field blank causes the claims for the selected insurance classes/codes to bill as group claims and take the rendering provider off.
Government Payers

Entering PROVIDER in the Individual Number (24j) and Group Number (33b) fields will pull the Taxonomy code from the Provider info and put that on the claim form. This is primarily used with Medicaid insurance classes.

Anywhere we recommend entering PROVIDER, you can place whatever text you’d like in the field. It’s simply the presence of text within the field that triggers the desired system behavior.

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