Medical Billing Forum
NPI Numbers => NPI Numbers => : Tifsmom1 April 21, 2014, 11:36:54 PM
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Should the Medical Directors name appear in box 31 of the CMS 1500 form when there is another rendering provider? This is for Mental Health in the state of Colorado. My understanding is that the rendering providers name should appear in box 24 J and again in box 31. Is this illegal and if so where can I get the rule stated in black and white to show the person in charge of correcting this?
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The rendering provider's individual NPI goes in 24J and their name goes in 31. The name in 31 should match the NPI in 24J. The medical director should not be on the claim unless they were the rendering provider. The only reason it would be different were if it were some specific rule for a specific carrier.
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Thank you, Is there anywhere that that is written so I could prove that to a supervisor whom doesn't agree and says that years ago that was how it waas done and doesn't know when that changed.
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For Medicare.. And I go back many years (eons) we never used the medical director. Perhaps as Michele stated it is for a specific company.
Merry
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No it doesn't appear to be for a certain company. This is why I question it.
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First I'd like to say that in the 20 + years I've been billing I've always used the name of the rendering provider in 31. It's not really an option. PMS systems automatically put the name of the rendering provider in that field. But when I tried to get proof this is what I found on the NUCC website:
DESCRIPTION: The “Signature of the Physician or Supplier Including Degrees or Credentials” refers to the authorized or accountable person and the degree, credentials, or title.
So that doesn't really clearly state that it must be the person whose NPI is in 24J
???
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I echo what Michele said here:
The rendering provider's individual NPI goes in 24J and their name goes in 31. The name in 31 should match the NPI in 24J. The medical director should not be on the claim unless they were the rendering provider. The only reason it would be different were if it were some specific rule for a specific carrier.
It also depends on how the NPI is setup and that needs to match IRS records.. EXACTLY!!! I had a provider who had all kinds of problems because his IRS record was not an exact match.. was missing an ' (apostrophe) in the name!! was 6 week PIA to fix. THEY MUST MATCH!!
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Search on "Item Number 31" (without the quotes) here:
http://www.nucc.org/%5Cimages%5Cstories%5CPDF%5C1500_claim_form_instruction_manual_2012_02.pdf
Enter the legal signature of the practitioner or supplier, signature of the practitioner or supplier representative, “Signature on File,” or “SOF.”
Search on "31" (without the quotes) here:
http://www.anthem.com/provider/me/f5/s2/t0/pw_041940.pdf
Signature of Physician or Supplier Including Degrees or Credentials
The signature of the physician or clinician who performed the services on the claim.
• If a group practice name appears in Box 33, the name of the physician who
performed the services must appear in Box 31.
• If the clinician who performed the services is a non-recognized professional (not
eligible to contract with us directly, i.e., physician’s assistant or certified nurse
anesthetist), the name of the attending, supervising or medically directing
physician must be entered here. The credentials must be included along with the
clinician’s name.
• Do not enter the name of a billing clerk or supervisor.
Note: It is appropriate to indicate the names of PAFAs or RNFAs in Box 31 as they
are eligible to contract with us.
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AHHHH! Thanks Richard! I knew it had to be the same but wasn't finding that documentation.
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You're welcome.
For those who may not have noticed, that first link is the instructions for filling out the new CMS 1500 (2-12) form.