Billing supervisors are needed on professional claims when a staff is not credentialed or registered with a specific payer. Procentive has the ability to setup a billing supervisor based on the staff, a payer, or a client. This article will explain how to do each of these.
A billing supervisor can be setup in three areas of Procentive, depending on the staff or client requirements.
- Based on Client: A supervisor may be needed based on a specific client's insurance policy. When this is the case, billing supervisors can be setup in the Clients Module.
- Based on Payer: A billing supervisor may be needed for specific payer if a staff has not yet become registered or credentialed with that payer.
- Based on Staff: A billing supervisor may be needed for a staff for all claim (regardless of the client or payer). This is most often the case when a staff does not have their own NPI or they have not yet registered with any payers.
- Procentive will look to the Clients Module, then the Payers Module, and lastly to the Staff Module for billing supervisory rules. Therefore, where you enter these rules will directly impact which supervisor appears on the claim.
- If there is more than one billing supervisory rule setup, staff can select the correct billing supervisor from the Time Add window.
IMPORTANT: If staff is in the process of becoming credentialed with payers, this is a unique setup to ensure the process goes as smoothly as possible. Please see the Billing Supervision During Credentialing Process for these specific steps.
Based on Client
- Go to the Clients Module.
- Double-click on a client.
- The Change Client window will open.
- Click the Staff tab.
- Select the staff that will be the billing supervisor from the pick list.
- In the Billing Supervisor for this client column, select the appropriate option from the drop-down.
- Yes - Default: Select this option if this staff should always be the billing supervisor for this client.
- Yes - Alternate: Select this option if the client will have more than one billing supervisor.
- Click Save.
NOTE: The staff selected as the Billing Supervisor must be set up in the Staff module > Role tab > Type drop-down as Therapy/Counseling.
Based on Payer
- Go to the Payers Module.
- Double-click on the payer to edit.
- The Change window will open.
- Click the Rates tab.
- Click the Staff sub-tab.
- In the Staff column, select the staff needing a billing supervisor from the pick list.
- In the Billing Supervisor column, select the staff that should be the billing supervisor appearing on your claims from the pick list.
- In the Sup. Req. column, choose Yes.
- In the Use Supervisor NPI column, choose Yes.
- Click Add.
- Click Save.
- If the payer requires a specific modifier to appear on supervised claims, enter the modifier in the Modifier column.
- If the modifier needed for supervision is HN, select the appropriate option from the HN Modifier column.
Based on Staff
- Go to the Staff Module.
- Double-click on the staff record.
- The Change Staff window will open.
- Click the Role Tab.
- In the field Billing Supervisor, click the pick list to select the billing supervisor.
- Click the Billing Tab.
- Change Require supervisor to Yes.
- Change Send supervisor name and NPI to Yes.
- Click Save.