Beginning on Friday, April 14, 2017, PrimeWest will require all institutional claims to include an Attending Physician and the Attending Physician's NPI in the 'Attending Physician' loop and segment on electronic claims. Currently, many customers send the clinic's NPI in this section instead of a staff NPI. After April 14, 2017, PrimeWest will deny any institutional claims that do not include the Attending Physician's name and NPI in the 2310A loop.
What you need to do:
- Verify with PrimeWest which staff from your agency are properly registered and credentialed with them for billing purposes.
- Go to the Staff module > Billing tab, confirm that the NPI for these staff have been correctly entered into Procentive.
- Go to the Payers module > Payer Rules tab for the PrimeWest payer. Make sure that the Source of NPI field is set to Staff.
- Go to the Payers module > Rates tab > Staff tab. You may need to set up the PrimeWest credentialed staff as the Billing Supervisor for any other providers who provide services but who are not properly credentialed for PrimeWest.
- After making the above changes, make certain that the 2310A loop on institutional claims includes the credentialed staff's name & NPI before sending.