Printer Friendly PDFUse of Therapist Locations and Master Info on Insurance Claims
How the Therapist locations and the Master Settings values are used in the values for the Service Facility (Box 32), Billing Provider (Box 33), and the Rendering Provider (Box 24J) on the CMS-1500 insurance claims.
User Settings - Therapist Primary Location entered
Siggy Freud (Therapist) has his Psychoanalysts-R-Us data entered for his primary office location in Sanity City.
User Settings - Therapist Secondary Location entered
Siggy Freud (Therapist) has his Shrink-N-Think Analysis data entered for his secondary office location in Shrinkville.
Master Settings > Master Display Info > Master User Info with NO Master values entered
No values are entered in the Master Settings for the Master User Info (and USE AS MASTER DATA is "No"). Therefore, Siggy's User values will take precedence for both Service Facility Location (Box 32) and Billing Provider Info (Box 33).
Master Settings > Master Display Info > Master Provider Info with NO Master values entered
No values are entered in the Master Settings for the Master Provider Info. Therefore, Siggy's User values will take precedence for both Service Facility Location (Box 32) and Billing Provider Info (Box 33).
Client Setup with Therapist Primary Location selected for this client
The Temple Family client is seen at Siggy's primary office location in Sanity City. So Therapist Location is set to Primary. (The primary address is displayed for confirmation.)
Insurance claim with No Master Data entered, Primary Therapist Location used for this client
The CMS-1500 form uses Siggy's user data for the (1) Rendering Provider NPI (Box 24J), and it uses his primary location info for (2) Service Facility Location Info (Box 32), and the (3) Billing Provider Info (Box 33). (4) Siggy's Tax ID is used as the overall claim Tax ID (Box 25).
Client Setup with Therapist Secondary Location selected for this client
Now the Temple Family client moves from Sanity City to Shrinkville, and they see Siggy at his second office location. So Therapist Location is set to Secondary.
Insurance claim with No Master Data entered, Secondary Therapist Location used for this client
The CMS-1500 form uses Siggy's user data for the (1) Rendering Provider NPI (Box 24J), and it uses his secondary location info for (2) Service Facility Location Info (Box 32), and the (3) Billing Provider Info (Box 33). (4) Siggy's Tax ID is used as the overall claim Tax ID (Box 25).
Master Settings > Master Display Info > Master User Info values entered
Values are entered into the Master User Info fields. (USE AS MASTER DATA is still set to "No.") These values will be used as the Billing Provider Info (Box 33) on the CMS-1500. Fields left empty will allow use of the Therapist User's (Siggy's) information. (The client is assigned back to Siggy's primary location.)
Master Settings > Master Display Info > Master Provider Info values entered
Values are (optionally) entered in the Master Provider Info fields. These values will be used in the Service Facility Information on the CMS-1500 (Box 32).
Insurance claim - Master Info & Master Provider Info values are used automatically if values have been entered
On the CMS-1500, (1) Siggy's information is used as the Service Provider Location (Box 32), while (2) PsychoHealth appears in the Billing Provider Information (Box 33), and (3) Siggy's Tax ID is used as the overall claim Tax ID (Box 25) since Master User Info values were entered, but "USE AS MASTER DATA" is set to "No." (4) Siggy's NPI is still used as the Rendering Provider NPI (Box 24J).
Master Settings > Master Display Info - USE AS MASTER DATA set to Yes
Now, the "USE AS MASTER DATA" is set to "Yes." (No other values are changed or entered.)
Insurance claim - Master Display Info with USE AS MASTER DATA set to Yes
With "USE AS MASTER DATA" set to "Yes," the (1) Master values are used for the CMS-1500 Service Facility Location (Box 32). (2) PsychoHealth also appears in the Billing Provider Info (Box 33) and (3) the Master Tax ID is used as the overall claim Tax ID (Box 25). (4) Siggy's NPI is still used as the Rendering Provider NPI (Box 24J). Note that since no Master Work Phone number was entered, Siggy's phone number is used for Billing Provider Info.