Author Topic: Medical Directors name on all claim forms  (Read 2382 times)

Tifsmom1

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Medical Directors name on all claim forms
« on: April 21, 2014, 08:36:54 PM »
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?

Michele

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Re: Medical Directors name on all claim forms
« Reply #1 on: April 22, 2014, 07:52:22 AM »
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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Tifsmom1

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Re: Medical Directors name on all claim forms
« Reply #2 on: April 22, 2014, 08:48:17 AM »
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.

Merry

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Re: Medical Directors name on all claim forms
« Reply #3 on: April 22, 2014, 08:55:40 AM »
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

Tifsmom1

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Re: Medical Directors name on all claim forms
« Reply #4 on: April 22, 2014, 08:57:53 AM »
No it doesn't appear to be for a certain company. This is why I question it.

Michele

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Re: Medical Directors name on all claim forms
« Reply #5 on: April 22, 2014, 09:38:55 AM »
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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PMRNC

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Re: Medical Directors name on all claim forms
« Reply #6 on: April 22, 2014, 02:58:55 PM »
I echo what Michele said here:
Quote
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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RichardP

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Re: Medical Directors name on all claim forms
« Reply #7 on: April 22, 2014, 06:04:31 PM »
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.

Michele

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Re: Medical Directors name on all claim forms
« Reply #8 on: April 23, 2014, 08:33:33 AM »
AHHHH!  Thanks Richard!  I knew it had to be the same but wasn't finding that documentation.
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RichardP

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Re: Medical Directors name on all claim forms
« Reply #9 on: April 23, 2014, 02:07:37 PM »
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.