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1500 CMC form

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gderilus:
I have a question regarding the claim form. I'm billing for a mental health provider and she was the only provider in the office. Now she has another provider coming in the office and they going to have 60/40 split for all AR. She will still be the billing provider meaning all the check would come under her name. My question is, would the new provider need to be in network with the insurance companies also in order to bill them or can I just put him down as the rendering provider and my provider would be the billing provider.

Michele:
The new provider must be credentialed with all insurance carriers.  When that is done they need to indicate that they will be working for the first provider, and that they are assigning all payments to be made to that provider.  Then they would be listed on the claim as the rendering provider, and the first providers billing info would be in box 25 and 33.

Michele

melissa_2004:
Hi Michele,

Since this provider will be working for the original does that make it not necessary to have a group NPI?  If they decide to partner or bill individually a group NPI will be needed at that time?

Melissa

gderilus:
I also have a few more questions, I'm new to billing and very confused. When the patient comes in and pay their copay, when you sending the claim to the insurance do you put the amount they pay in the claim also and put the charge for the service date, or do you just put the charge only not the copay.

Pay_My_Claims:
u have to post copay

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