Incomplete Constants: Providers

There are two key processes you'll need to complete for your providers in WebPT Billing:

1. Update the Provider Code to remove the provider from the Incomplete Constants worklist
2. Add Provider Credentials in the Billing Settings

Updating the Provider Code 

Providers added in the WebPT EMR automatically flow into the WebPT Billing database with a ZZZ provider code and appear on the Incomplete Constants report. This code must be updated to remove the provider from the worklist.  Important: Before entering a new provider in the WebPT EMR, confirm that the provider is not already in the system in another location, under a previous name, or login. Adding duplicate providers creates issues for the front office, billing, and reporting. Click here to learn how to add a provider.

1. Navigate to Admin, and select Incomplete Constants. 
2. Choose your Search Criteria, then click Search. 
3. For users with access to multiple companies: If you do not narrow down the search results to the company you're currently logged into, opening an incomplete constant in another company will automatically log you into that company. Be sure to change back to your preferred company once you've completed your updates.
4. Click on the Count number for the Providers Data Type from the search results. 
5. New providers come over with a ZZZ provider code, which needs to be updated. Click on the Provider Code column header to sort. 
6. Locate the new provider on the list, and click on the Provider Code.
7. Provider Information: In this section, you must update the Provider Code. This field is used to identify the provider in reporting. While this field can be any number, we recommend updating this code to the next number in your provider sequence. 
8. Open a New Tab (once open, move the tab over to your other screen, if available).
   
9. On the new tab, identify the next available Provider Code from the Providers page. Go to Admin and select Providers. 

10. Check the Include Inactive box, then click Search. 

11. Sort the list by clicking on the Provider Code column header to determine what the next number should be. (i.e. in this screenshot 112 was the last provider, our next provider would be 113). 
12. Return to your original tab and enter the new Provider Code.
    
13. Ensure the following fields are completed: 
    1. Provider Description:  The provider’s full name listed on their state license, followed by the specialty (ex. Annie Ann, PTA). 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 
       • Billing Provider: A provider who is credentialed to bill claims (can be a cosigner).
       • 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).
       • Student: A student completing their clinical hours.
       • 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 is required for Billing and Treating Providers. If needed, please use 1234567893 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.

Billing Settings

The Billing Settings card establishes certification for Insurance Classes that have the Provider Credentials Required flag set for these five government-based insurance companies: Medicare, Medicare Advantage, Medicaid, Medicare Railroad, US Department of Labor.

Important: Until the provider credentials are added, all claims for these Insurance Classes that have Provider Credentials Required flagged 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, include the Insurance Code and Individual Number in the billing settings below.

Adding Provider Credentials 

1. Locate the provider by opening the Admin menu and select Providers. 
2. Use the available Search criteria to locate and open the provider record.
3. From the Billing Settings sections, click on the New button.
4. From the credential builder drawer, complete the fields required to build your credentialing rules for the payers and locations where the provider treats.

   

   1. Setting Name: Name this 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 Identification 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, 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". 
5. 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, select the Insurance Code here. Use the Reset link in the lower-left to unselect the insurance codes.

6. Click  Save.

   

7. 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 the following alert. You’ll need to remove the conflicting combination to save the setting.

8. Your credentials appear in the Billing Settings. You can make edits by clicking on the setting to re-open the credentials window.

What causes a Provider to appear on Incomplete Constants? 

A provider will appear on the incomplete constants report if any of the following fields are blank: 

• Provider Type 
• First Name 
• Last Name 
• Taxonomy 
• NPI
• Primary Specialty 
• State License Number