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Billing Under a Different Practitioner (Rendering Provider)

Sometimes, you might book a patient into one practitioner’s schedule, but you need to bill the patient’s claim to insurance under a different practitioner or Rendering Provider (Box 31 on the CMS1500). You might run into this scenario at your clinic if you employ students, recent graduates who aren’t yet credentialed, or if you “split” services amongst practitioners (i.e. a chiropractor and massage therapist both treat a patient during a single encounter).

This guide covers how you can bill a claim under a different practitioner. There are two ways you can do this depending on your billing needs. You can either set up a staff member’s Billing Settings so that Jane bills under a different practitioner by default for every claim, or you adjust appointments on a case-by-case basis.

Option 1: Default to bill under a different practitioner every visit

When you set up your Staff Billing Settings (part of US Insurance Step 3 onboarding training), you’ll see an option to Bill Under a Different Name or Rendering Provider?.

If you check this option, then you can enter the First and Last Name that you’d like to be sent as the Rendering Provider by default on all your claim submissions. This applies to paper (CMS1500 - Box 31) and electronic claims.

If you don’t check this option, the Jane will use the First and Last Name that you’ve entered in your Staff Profile.

Pro Tip: If you’d like to go by something other than your legal name, but you’re required to bill under your legal name, then enter your the name you’d like patients to see and use in your Staff Profile, and enter your legal name required for billing insurance within your Staff Billing Settings.

Option 2: Bill one visit under a different practitioner

If you’d like to bill under a different provider for a given appointment, you can do so by changing the Staff Member Receiving Compensation within the Purchase screen. By default, the Staff Member Receiving Compensation will be the staff member with whom the patient is booked.

To do this from the schedule, you can hover your mouse over the Billing Info section of the Appointment Panel and click the blue View button that appears. This will lead you to the Purchase screen, where you can use the blue Change text next to the Staff Member’s name to switch Practitioners.

An important difference between this option and option 2 is that changing the Staff Member Receiving Compensation affects your Reports (Option 1 only affects paper and electronic claim submissions). Specifically, this change affects the Compensation Report. Jane will compensate the practitioner listed as Receiving Compensation, so making this change will affect the Scheduled Staff Member’s compensation in addition to the Rendering Provider info sent on the claim.

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