Referring Provider Numbers

athenaCollector

athenaOne for Hospitals & Health Systems

This page allows you to view a list of referring providers with their provider numbers (including PIN, UPIN, and medical license numbers) for every provider number category or insurance package for which they are currently credentialed. You can also add, update, and delete referring provider numbers.

 

Referring providers are providers (both inside and outside your practice) who can refer patients to providers in your practice. Many managed care plans require the names of referring providers and their provider numbers to be listed on a claim (CMS-1500 17/17a). In order for this information to be sent, the outside referring provider must be registered in athenaOne.

 

On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Providers, click Referring Provider Numbers

 

 

 

  1. Display the Referring Provider Numbers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Providers, click Referring Provider Numbers.
  2. Provider Number Category — Select the provider number category for this referring provider, or enter the Insurance Package for this referring provider number. (You can type a period or ? to access the insurance package lookup tool.)
  3. Referring Provider — Select the referring provider (see also Referring Providers for setup information).
  4. Referring Provider Number — Required. Enter the referring provider's provider number for this insurance package or provider number category.
  5. Click Add. The new provider number appears in the list below.

 

  1. Display the Referring Provider Numbers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Providers, click Referring Provider Numbers.
  2. Locate the referring provider whose number you want to update. You can use the filter fields to generate a list of referring providers that match your criteria.
  3. Click the update link of the referring provider number that you want to update. The referring provider number detail appears at the top of the page.
  4. Update fields as needed.
  5. Click Save.

 

  1. Display the Referring Provider Numbers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Providers, click Referring Provider Numbers.
  2. Locate the referring provider number you want to delete. You can use the filter fields to generate a list of referring providers that match your criteria.
  3. Click the delete link of the referring provider number you want to delete. A warning message appears. Click OK to delete the number or Cancel to keep it.

    Caution: There is no undelete option. You can restore a number only by adding it again.

 

 

Provider Number Category

The provider number category associated with this number.

This list is maintained by athenahealth.
Insurance Package

The insurance package override for this number.

Either the Provider Number Category or the Insurance Package should be set; if the Insurance Package is set, that value overrides the Provider Number Category upon claim lookup. In general, only the Provider Number Category is required.

In other words: if you set the insurance package 123 to the ABC provider number category, then whenever insurance package 123 appears on a claim, and athenaOne uses the ABC provider number (if one has been entered). But if insurance package 123 appears as a specific entry in the Provider Number Category table, then athenaOne prints this number on the claim.
Referring Provider

The referring provider, as set up on the Referring Providers page.
Referring Provider Number

Required. The referring provider number for this provider number category or insurance package.
Show Referring Provider Numbers
Insurance Reporting Category

The insurance reporting category to which the referring provider number belongs.
Provider Number Category

The provider number category to which the referring provider number belongs.
Last Name

The referring provider's last name.
First Name

The referring provider's first name.
Column Headings on Referring Provider Numbers
Referring Provider

The referring provider, as set up in the Referring Providers page.
Provider Number Category

The provider number category associated with this number.
Insurance Package

The insurance package override for this number.
Provider #

The provider number of the referring provider for this provider number category or insurance package.

 

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