SUPERVISING PROVIDER FOUND BUT NOT EXPECTED
INTERNAL, VAR & CUSTOMER
Problem or Issue
Due to an unexpected behavior in Practice Partner Medical Billing v11, the supervising provider loop is being created unless turned completely off. This is causing carriers that are using UHC’s clearinghouse to reject claims for having duplicate information in the rendering and supervising provider loops of the 837p electronic claims being sent. In the 4010 spec the way we processed supervising providers was to replace the rendering provider with the supervising provider. In 5010 the ability to send both the actual rendering provider as well as the supervising provider was added. Carriers have, until now, not taken advantage of this new functionality. Many carriers are still using the replacement method of receiving supervising providers. If you do not use supervising providers at all, the following steps will correct this issue. Practices that have claims with supervising providers to UHC or carriers using the UHC clearinghouse may use the following steps to correct their claims that do not have a supervising provider but should hold their claims with supervising providers at this time. We are currently testing the ability of UHC’s clearinghouse to properly process and pay claims with the rendering provider in 2310B and their supervising provider in 2310D; instructions for sending supervising providers to these carriers is forthcoming and will be posted here when testing has been complete. Carriers still using the replacement method should not be affected by making these changes as well. .
1. Make a backup copy of the hcfaclaimconfig.xml and ubclaimconfig.xml files located in the PPART directory.
2. In the PPART directory, open the claimconfigurationutility.exe.
3. In the claim configuration utility, on the left hand pane, expand the ‘Item’ tree.
4. Scroll down the expanded list to ‘SupervisingProvider’ and highlight it. Change the selected Data Source option to ‘Suppress’ with a Value of ‘Suppress’.
5. Click the ‘Save’ button in the lower left hand corner, then the ‘Exit’ button.
You can also Download the original file attached to this KB article.