Signature of Provider & Provider Credentials

What’s in the box?

The first part of this box contains the credentials and name/signature of the rendering provider. By including their name, the rendering provider certifies that the information in the claim is correct. The second part includes the date that the form was signed.

Where does this info live in Jane?

The rendering provider’s first name, last name, prefix, and credentials are used to populate this box. This information can be found in a Staff Profile’s Edit/Settings area.

The rendering provider is typically the staff member who the patient is booked in with, but not always (see the Billing Under a Different Staff Member section below for more info).

The date the CMS1500 form is generated is the date that will be used in box 31 by default.

Billing a Under a Different Staff Member

Do you need to bill a claim under a different practitioner? Do you need to bill all visits booked with a specific staff member under someone else?

If so, check out the following guide to learn more:

📍[Bill Under a Different Rendering Provider](https://jane.app/guide/suffix** are optional. Only enter a prefix or credentials if required by the Insurer(s) you support. Please note that these fields affect other patient-facing areas of Jane.

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How and where it’s used in EDI files:

The rendering provider’s first name and last name are included in Loop 2310B - Rendering Provider info.

Specifically:

• The rendering provider’s last name is sent in Loop 2310B, Segment NM103
• The rendering provider’s first name is sent in Loop 2310B, Segment NM104

Note: the rendering provider’s prefix and credentials/suffix are not included on EDI files generated in Jane. Likewise, there isn’t an equivalent field on the EDI that represents the date in box 31 on the CMS1500.