Medicaid, Tricare Service Providers & Tricare Session Times

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Medicaid, Tricare Service Providers & Tricare Session Times

Tricare, Georgia Medicaid, and Florida Medicaid require the service provider’s ID to be included on claims for selected services. This document will show the user how to set up a Service Provide ID and how that ID is used when generating claims.

Adding a Service Provider ID

  1. Open a staff record. On the General tab, click on the Special Identifier button.
  2. On the Special Identifiers page, click the add button.
    1. If the staff member has a register NPI number, select Type [NPI], enter the ID in ID / Number / Code and check Service Provider. Click OK to close the page.

      Please note, if the staff also has a special identifier type of [NPI] and Rendering Provider is selected, the staff will be treated as a rendering provider for Tricare claims and the Service Provider rules will be ignored.

    2. In the past, Tricare has accepted an SSN as a Service Provider ID but has announced that all providers will need an NPI. If the organization is still using social security numbers as service provider IDs, select Type [SSN], enter the SSN in in ID / Number / Code, and do not check any Identifiers. Alternatively, the user can center the staff’s SSN on the General tab of the staff record.

Tricare, Florida Medicaid, and Georgia Medicaid Service Provider claim requirements

  • If the service is direct intervention and the staff member for the appointment does not have a Rendering Provider NPI number, the provider in this case is called the Service Provider.
  • A separate claim must be created for each Service Provider/Place of Service. If the Service Provider’s ID number is an SSN, the SSN and the Qualifier “G2” are displayed in the pink section above the charge line in Box’s 24I and 24J. If the Service Provider’s ID is an NPI, the NPI is displayed in the white section of 24J with no Qualifier.  The provider’s name is displayed in Box 31.

Tricare Session Times.

  • NOTE: For Tricare claims only, when the 837P file is exported or sent to the clearinghouse the session times will be added to the claim. If there are multiple appointments for the same Provider, Place of Service, and CPT Code on the same day, the start and end times of each CPT Code is included in the 837P file separated by a comma (e.g., 1000-1200, 1300-1500).
  • In a future release, session times will also be displayed on the CMS 1500 form in the pink section above the charge line in Box 24A.

Funding Source set up

In order for Claims Wizard to apply the proper Service Provider requirements for Florida Medicaid, Georgia Medicaid, and Tricare, and for Session Times to be displayed for Tricare, the one of following must be included in the Funding Source Name:

  • Tricare
  • FL Medicaid
  • GA Medicaid

The name can contain additional information such as Tricare Ventura County in the example below.  In a future release, the an option will be available on the Funding Source record to indicate that Service Provider and/or Session Time requirements are to be applied without having the enter specific text in the Funding Source name.

Generating Claims in Claims Wizard

Claims Wizard will display Service Provider IDs when claims are generated for Funding Sources that have Tricare, FL Medicaid, or GA Medicaid in the funding source name. The Service Provider ID is displayed in Steps 1, 2, and 3 of the Claims Wizard to the right of the Rendering Provider. Information that is required for every claim is grouped together so it is visible without having to scroll to the right in the screen (Place of Service, Rendering Provider, etc.).

Step 1 of the Claims Wizard:

Step 2 of the Claims Wizard:

Step 3 of the Claims Wizard:

 

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