Understanding Rendering Provider: Part 5 – Billing Scenarios and Potential Denials

Summary

As organizations work with health insurance funders, one of the most critical items to thoroughly understand is how to use the Rendering Provider appropriately on claims.

Over the first 4 parts of our Rendering Provider Series, we have set the foundation for elements related to the appropriate set up and use of NPI numbers for each provider type as it relates to the submission of claims.

In this post, we will discuss some potential denials or recoupments that can occur if these steps are not followed.

Find additional information in the other parts to this series below.

Other Posts in this Series

As organizations work with health insurance funders, one of the most critical items to thoroughly understand is how to use the Rendering Provider appropriately on claims.

As we take this journey into the importance of the Rendering Provider, let’s first start with the NPI number for an organization and individual providers, Taxonomy codes and a Tax Identification number. We’ll cover what each are, why they are important and when they are used. Read more.

As organizations work with health insurance funders, one of the most critical items to thoroughly understand is how to use the Rendering Provider appropriately on claims.

If a provider or organization chooses to become in network with insurance, there are various elements to know about the contracting and credentialing process. Read more.

As organizations work with health insurance funders, one of the most critical items to thoroughly understand is how to use the Rendering Provider appropriately on claims.

Contracts and payor policies determine the guidelines for how to submit claims and determine the difference between billing, supervising, and rendering providers. Read more.

As organizations work with health insurance funders, one of the most critical items to thoroughly understand is how to use the Rendering Provider appropriately on claims.

Contracts and payor policies determine the guidelines for how to submit claims and determine the difference between billing, supervising, and rendering providers. Read more.

About Our Presenters

Lindsay Chapman

Content Developer, Technical Development

Lindsay joined ABAB in 2015, when she was a young mother of her two children, looking for some part time work. She was curious about the work at ABAB, and after inquiring about the company, found a home in the role of posting payments as part of the original ABAB team. She has since taken on a variety of roles, responsibilities, and tasks within the organization, which has allowed her to gain more knowledge and skills in the field of ABA Therapy billing. She is constantly learning and developing, allowing her to experience both personal and professional growth.

She is currently the ABAB Training and Development Department, developing training materials and content for the ABAB internal team. She enjoys utilizing her creative side in this role to help ABAB grow and develop as a company. She also enjoys researching and looking at complex scenarios to help resolve issues and complete reconciliation projects.