Re: Definitions of Various Physician Roles as defined in the 837I and P

[Doug Webb]

I don't know about an Official Source, but here's my understanding: The Billing Provider is who is submitting the claim. The Pay-to Provider identifies where to send the payment. The Admitting provider is the provider who authorized admission to the institution.  There is no place to report this in the 837I or 837P.  In most cases, it will be the Attending or Referring provider. The Attending provider is the provider who is responsible for the patient's healthcare while in the institution.  As such, it is appropriate only on the 837I.  If tests are ordered that are reported on an 837P, this provider is usually the one issuing the order. The Operating provider is the surgeon if surgery was performed and reported on the 837I.  On the 837P, the Operating Provider would be the Rendering and Billing Provider, if reported at all. The Referring Provider is the one who referred the patient to the Billing Provider.  It is also used to report the Ordering Provider at the Claim Level on the 837P, if appropriate. The Primary Care Provider is the provider who is responsible for the patient's overall healthcare (HMO "gatekeeper") [only reported if a Referring provider was already reported] The Purchased Services Provider is the provider from whom services were purchased.  It is only reported if the Purchased Services were billed to the patient by the Billing Provider.  Otherwise, the Provider the services were purchased from issues its own 837. The Ordering Provider is the provider who ordered the test being billed for.  It is only appropriate on the 837P.  There is only a place to independantly report this at the line item level..  It may be reported as the Referring Provider at the claim level.  This is usually the Attending Provider if the patient is an inpatient, and the Primary Care Provider or Referring Provider if the patient is an outpatient. The Supervising Provider is responsible for the patient's overall healthcare when services are rendered by various specialized providers that require supervision, such as Therapists, Podiatrists, and various specialized-care Institutions, such as a Skilled Nursing Facility. Any other Provider associated with the claim is the "Other" Provider   The opinions expressed here are my own and not necessarily the opinion of LCMH.   Douglas M. Webb Computer System Engineer Little Company of Mary Hospital & Health Care Centers [EMAIL PROTECTED]   "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s)  named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately,  delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you."     ----- Original Message ----- From: [EMAIL PROTECTED] To: WEDI SNIP Transactions Workgroup List Sent: Tuesday, September 16, 2003 02:33 PM Subject: Definitions of Various Physician Roles as defined in the 837I and P Does anyone know of an "official source" that can be used to secure the definitions of the various physician roles as called for in the Implementation Guides for the 837 claims?  For instance, I capture the following physician roles on my registration and abstracting  pathways: Admitting, Attending, Surgeon, Referring, Primary Care. I am having difficulty in mapping these traditional physician roles to those that are defined in the IG, specifically for the 837P.  If anyone knows of any official repository for definitions of these roles (Rendering, Supervising, Ordering, Referring) I would sure appreciate having that information.  In speaking with one of our major payers, they are having the same difficulty.  My guess is that : Rendering equates to Attending, Referring or Primary Care both equate to Referring Supervising has no match to the traditional roles (possibly used to define the Medical Director of ancillary service) Ordering is typically the same as the Attending except when a physician other than the attending places the order Any feedback would be appreciated.  Thanks. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- This message and attachments are from Tampa General Hospital and are intended solely for the addressee(s).   Access by anyone else is unauthorized.  The information contained herein may include confidential information that is protected by federal and state laws.  If you are not the intended recipient, unauthorized review, forwarding, printing,copying, distributing, or using such information is strictly prohibited and may be unlawful.  If you received this message in error, or have reason to believe you are not authorized to receive it, promptly notify Tampa General Hospital's Security Officer at [EMAIL PROTECTED] and then delete the message and its attachments. 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