Billing Supervision During Credentialing Process (Procentive)

The transition period of the credentialing process is one that needs to be managed carefully to ensure that billing for the clinician's services goes smoothly. This article will provide the steps needed to walk through this period in the most efficient way possible.   

  Permissions needed: 

Initially, the clinician will need to be set up with a billing supervisor in each Payer that will be billed. This involves specific settings in the Staff module as well as the Payers module.

Staff Module

1. Go to the Staff module > Role tab.
   
   
   
   
2. Ensure that the Billing Supervisor field is blank.
3. Go to the Billing tab.
   
   
   
   
4. Enter the staff's NPI number in the National Provider ID field.
5. For the Require supervisor setting, select No.
6. For the Send supervisor name and NPI setting, select No.
7. Click Save.

Payers Module

1. Go to the Payers module and select the payer that will be billed.
2. Go to the Rates tab > Staff subtab.
   
   
   
   
3. Add the newly licensed staff in the Staff column.
4. Add the Billing Supervisor in the Billing Supervisor column.
5. In the Sup. Req. column, select Yes.
6. In the Use Supervisor NPI column, select Yes.
7. Click Save.
8. Repeat steps 1-7 for each Payer that will be billed.

As the newly licensed staff becomes credentialed with each payer, follow these steps to remove the billing supervisor for that payer.

1. Go to the Payers module and select the payer that they are now credentialed with.
2. Go to the Rates tab > Staff subtab.
   
   
   
   
3. Find the newly licensed staff.
4. Remove the Billing Supervisor in the Billing Supervisor column.
5. In the Sup. Req. column, select No.
6. In the Use Supervisor NPI column, select No.
7. Click Save.
   

   IMPORTANT: Avoid removing the staff line completely so that if any service lines from when the staff was not credentialed and still under supervision need to be rebilled, it will be easier to temporarily change the settings to rebill for these services. Then, simply change the settings back after rebilling.

If service lines from prior to when the staff is credentialed need to be rebilled, follow these steps to change settings back to reflect a billing supervisor.

1. Go to the Payers module and select the payer that needs to be rebilled.
2. Go to the Rates tab > Staff subtab.
   
   
   
   
3. Find the newly licensed staff.
4. Add the Billing Supervisor in the Billing Supervisor column.
5. In the Sup. Req. column, select Yes.
6. In the Use Supervisor NPI column, select Yes.
7. Click Save.
8. Rebill the service lines.
9. Go back to the Payers module > Rates tab > Staff subtab.
   
   
   
   
10. Find the newly licensed staff.
11. Remove the Billing Supervisor in the Billing Supervisor column.
12. In the Sup. Req. column, select No.
13. In the Use Supervisor NPI column, select No.
14. Click Save.

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