Commercial Contract Setup Example
Requiring Billing Under the BT/RBT
Requiring Billing Under the BT/RBT & Time Designation
Medicaid Contract Setup Example
Requiring Billing Under the BCBA
Requiring Billing Under the BT/RBT
Requiring Billing Under the BT/RBT & Time Designation
Tricare Contract Setup Example
Non-Organization Contract Setup Example
Basic Setup Explanation
- NPI Used in Claims: This will translate to box 24J on the claim form as the rendering provider.
- Aggregation Rule for Claims: This will dictate how units per CPT code are displayed on the claim form.
- One Row per Session, No Aggregation: Units will display per rendered session on the claim form (i.e. if a patient is seen by multiple therapists within the same-day, each session’s unit duration will display as a separate line on the claim form).
- Aggregate per Provider per Day: Units will combine per provider, per service & DOS on the claim form (i.e. if a patient is seen twice in one day by the same provider, but different times, those units will combine onto one line on the claim form). Note: This aggregation rule will combine units for the same CPT code/provider/pos combination. The pos will be differentiated on the claim if they vary but are performed by the same provider (i.e. school & office on same dos).
- Aggregate per Service per Day: Units will be combined per CPT code & DOS onto one line on the claim form (i.e. if a patient is seen by multiple therapists within the same-day, all session’s unit duration will combine to display overall units on the claim form). Note: This aggregation rule will combine units for the same CPT code/provider role (if differentiated by a modifier)/POS combination.
- Federal Tax ID: This will be the tax ID utilized/set up to receive insurance payments.
- Signature of Physician or Supplier Including Degree or Credentials: This should match the information designated within the NPI used in claims section.
- Service Facility Location NPI: This will be the NPI utilized for the location in which services were rendered (i.e. if billing from a clinic credentialed under the group’s NPI, the organization’s NPI should be designated).
- Billing Provider Name: This is determined based on how you are credentialed with the payer.
- Organization: If credentialed as a group with the payer, the organization should be designated.
- Patient Supervisor: If credentialed as an individual with the payer, patient supervisor should be designated.
- Location Name: If you are credentialed as a level 2 NPI, the location should be designated.
- Billing Provider NPI: This should match the information that corresponds to what is designated within the billing provider name section.
Billing Compliance
This section is utilized to designate additional specific payer requirements. Note: If any of the above toggles are turned to “yes” the system will prohibit billing of services should any of the “yes” designations be missing.
Commercial Contract Setup Example
Requiring Billing Under the BCBA
Requiring Billing Under the BT/RBT
Requiring Billing Under the BT/RBT & Time Designation
Medicaid Contract Setup Example
Requiring Billing Under the BCBA
Requiring Billing Under the BT/RBT
Requiring Billing Under the BT/RBT & Time Designation
Tricare Contract Setup Example
Non-Organization Contract Setup Example
