Do you need to replace a provider’s identifiers on claims with a different provider’s values, or implement other unusual claim configuration requirements?
You can contact PCC Support for most claim configuration needs. PCC also includes an under-the-hood configuration program, Provider IDs (
provids), which can override standard identifier information that appears on claims. Use
provids to set an alternate provider for claims, or to enter custom values for the name, Taxonomy code, NPI, Tax ID, eligibility, or legacy ID numbers.
Use to Control Claim Output, Not Your Billing Record: When you configure provider information or select a billing provider as you post charges, both the chart and billing record will reflect that change. The
provids program, however, changes identifier information on outgoing claims as they are generated and submitted, when you run
preptags/ECS or print a paper claim with
hcfa. With that in mind,
provids should be used last, and only in situations where other solutions are insufficient… or a carrier has very unusual requirements.
Run provids, Select an Insurance Batch and a Provider
You can run the
provids program from the Insurance Configuration (
insconfig) program found in the Partner Configuration window of your Partner Windows. You can also type
provids at a command prompt.
After you run
provids, select the insurance batch with which you wish to work. Remember that you may have both a paper (HCFA) and an electronic (ECS) claim batch for each carrier. Choose the correct batch and press Enter.
The first provider you will see is the blank, or “None” provider entry. Press Page Down to cycle through all providers on your system. The provider name and counter in the upper-right corner will help you keep track of whose identifiers you are currently editing.
The top section displays the provider’s current Tax ID and NPI numbers, as recorded in the Providers table of the Table Editor (
ted). If you wish to update the provider’s Tax ID and NPI numbers for all insurance carriers, use
Jump to a Provider
You can cycle through each provider by pressing Page Down and Page Up. Press F8 – Jump to Provider and enter a provider name to jump directly to their
Set an Alternate Provider
If you need Partner to complete replace a provider’s identifiers with another provider’s identifiers during billing, use the provids program. After running provids and selecting an insurance batch and provider, enter the new provider in the Claim Provider field.
Outgoing claims for the provider shown at the top of the screen will now contain the claim provider’s identifiers. This will only occur for the chosen insurance batch. When you submit your claims electronically or print HCFA forms, Partner’s claim generating program will replace the provider name, NPI number, and Tax ID number.
Override Default Provider ID Values
You can configure Provider names, Taxonomy code, Tax ID, and NPI numbers in the Providers table in the Table Editor. However, you can enter custom values per-Insurance Batch in the Provider Table Override fields in provids.
No matter which provider appears in the Claim Provider field, entries in the “Provider Table Override” fields will take precedence. Avoid using both a claim provider and the override fields at the same time. However, if a claim provider is selected, any override fields with content will be used first, and Partner will refer to the claim provider or the original provider only for those left blank. You do not need to fill out every field in the Override section.
Enter Legacy Insurance Identifiers
Before the complete implementation of the National Provider Identifier, insurance carriers had their own set of identifiers. These might include a PIN, Group, Eligibility, or other ID number. You can still implement these fields on claims using
In the example above, the Ins ID and Alt ID numbers, along with the Insurance Eligibility number, may appear on this provider’s claims. The provider’s Tax ID and NPI numbers will be those entered in the Table Editor (
ted), as shown in the top section.
Changes May Not Affect Claims: Are your claims configured to display the NPI number? Or are your claims configured to show the PIN and Group numbers? Changing the Legacy Identifiers will only change your claims if they are configured to use those identifiers. Once PCC configures your claims to use the new NPI number, the legacy fields may be ignored. Contact PCC for further assistance.