Claim Payer Settings

practiceQ supports various settings and overrides on specific insurance payers for claims, which allows you more flexibility for varying insurance claim situations.

Once you've added a payer under "Lists > Claims > Claim Settings > Payers" you have the option to set various overrides, as outlined below.

Out of Network / Force Rendering Provider NPI

I'm an out-of-network provider with this payer (send payments to client): Checking this will set the field "Accept Assignment" to "No" by default on claims for this payer. Use this when you are submitting a claim on behalf of a client (payment is sent to client).

Force rendering provider NPI on claim: Checking this will force claims to include the rendering provider, even when it's the same as the billing provider (by default if they are the same we don't include the rendering provider).

Additional Provider IDs

To set additional provider IDs that will appear on claims, select the "Add Provider ID" option under that section. You'll be able to select a practitioner, qualifier, and ID as shown below:

CPT Overrides

You can click "Add CPT override" to override specific procedure codes on claims with a different modifier and price based on the CPT code and place of service, as shown below:

Supervisor Relationships

This option allows you to set an NPI override for specific practitioners in supervisor/supervisee situations. When the supervisee creates a claim, the NPI would default to the supervisor as opposed to the supervisee's NPI.