IV: Configuring the Provider Master File for Billing Flashcards
What is the INI for Provider REcords?
SER
What is the INI for Provider Attributes
PAT
What is the difference between a service provider and a billing provider?
A billing provider doesn’t necessarily be the service provider. Instead a billing provider’s license is used for claims when going out the door.
In Provider Information, the status field controls provider’s use in charge entry, T or F?
False. This field is used for scheduling and if the provider can be used as a PCP
If you add specialties to a provider record in text, where can you see the specialties in Hyperspace?
in Charge Entry under “Session”
Key Field: Provider Name
Name of provider or resource.
Key Field: Provider Type
Provider’s classification in terms of education and services provided. Determines procedures a provider can perform, pricing info.
Key Field: Ref Src Type
Required field. Can the provider be selected as a referral source (How a patient found out about the clinic) or can they be selected as “referred by”
Key Field: Specialty
Used to categorize services performed by the provider.
Key field: Status
current state of the provider’s employment (Active or Inactive).
If a provider is inactive can they still go out on a claim?
Yes. If inactive, they cannot be used in Cadence or as PCP
Provider SA field
List of Service areas authorized for this provider. If left blank, the provider is authorized for all SA.
Settings to define service and billing provider dates are found on what screen?
Provider Effective Dates and Attributes Screen found in the PAT Master File (via F6 or F7)
If a service provider is not a billing provider and the billing provider is blank under PAT, what shows in the charge entry screen?
Blank.
Why do you need to put hyphens on fields that are not being used in PAT under exception?
To save the changes.
Service Provider Key Fields: Effective Dates
From Date: Date you created the contact
To Date: Calculated when you create a new contact
Service Provider Field: Contact Status
Active, Inactive or Deleted
Service Provider Field: Service Provider?
Yes or No.
Provider/Resource Information Screen; Provider Type
Person or Resource or Class (Provider, Equipment or Room)
Provider/Resource Information Key Fields: Departments
Used to assign departments where provider will be scheduled to see patients. First department listed is the primary location for provider.
When setting up a provider as a non-billing provider, what else must you make sure is set up in RPB so Charge Entry will respect the non-billing set up?
Set up charge review WQs with a rule that looks for non-billing providers being used as billing provider.
