Setting Up Provider Insurance Details for Individual Carriers

For individual non-VSP carriers, you can enter:

  • Provider Billing and Rendering Provider NPIs - These NPI numbers will override the entries in boxes 33a and 24J on the claim form when you create claims for the provider for that carrier.
  • Provider Taxonomy Codes
  • Tax IDs

You can also select what information to display in the Provider Billing Information (Box 33) section on the claim form, if the NPI Type for the carrier is set to Group.

For VSP plans, the system uses the Provider NPI number entered in Add/Edit Provider.

  1. From the menu, select Resources and then Provider Setup.
  2. Locate the provider in the list, and click Insurance Details.

    The Insurance Details window opens.

  3. If you need to add a new carrier, click + Add.
  4. Select the Carrier.
  5. Select an NPI Type.
  6. Record the provider's Legacy ID, if required by the carrier to retrieve eligibilities.
    • Some carriers use a PIN instead of a Legacy ID number. Enter the PIN in this field.

    • The number entered in this fielddoes not appear on the CMS 1500 form.

  7. Enter the Rendering NPI for the provider.
  8. Record the provider’s Tax ID.
  9. If the NPI Type is set to Group, select the Provider Billing Info to display in Box 33 on the claim.
  10. Record the provider's Billing NPI.
  11. Enter the Provider Taxonomy code. This information will be added to Box 33b on the claim.
  12. To add NPIs and Tax IDs for additional carriers, click + Add.
  13. Click Save.