The New Insurance Paradigm (NIP) setup allows billing based on the rendering provider, meaning the person who performed the services on the patient. While this offers greater flexibility, it can also increase the potential for human error.
Difference Between Legacy Method and NIP:
Legacy Method: Utilizes bulk/blanket settings for billing, making it impossible to specify different providers for individual services.
NIP: Allows the billing provider to be set on individual services, based on who actually rendered the service. This provides more specific and accurate billing.
Since you can assign the billing provider on a per service basis, this negates the need for default billing provider under the case settings, patient profile, or office info. These settings change nothing on a claim if NIP is enabled.
The only thing that dictates what provider is being billed is the Provider field on each individual service.
Key Features:
Individual Service Billing: The billing provider is determined on a per-service basis, eliminating the need for default billing providers under case settings, patient profiles, or office info.
Automatic Selection: By default, the rendering provider is chosen based on the calendar user where the appointment was scheduled. For example, if an appointment is on Dr. Albus Dumbledore’s calendar, he will be the default rendering provider for that service.
Manual Adjustment: The rendering provider can be changed using the drop-down arrow on the Provider field in the transaction modal. The drop-down list includes users visible on the location users page.
Post-Ledger Changes:
If a rendering provider needs to be changed after charges have been added to a ledger, services can be edited by clicking the edit button in the edit column and updating the Provider field in the transaction modal.
NIP Setting Location:
Path: Location > Settings > Office > Office Configuration > New Insurance Paradigm
Challenges and Considerations:
Shared Calendars: Offices with multiple providers using one shared calendar or using calendars named after treatments (e.g., Chiro Team, Massage, Laser) might face difficulties. The billing provider defaults to the name on the calendar, which can lead to errors if not managed correctly. In this situation, the office would need to manually select the Provider on every service every time.
Greensheet: If an attempt is made to bill a service under a non-provider name (like Laser) and that user is not set up under the Providers tab, the claim will not process correctly (it will "hit the greensheet").
In summary, the New Insurance Paradigm allows for billing based on the actual provider rendering the service, offering more precise billing but requiring careful management to avoid errors.
Video Tutorial
For a detailed walkthrough, watch the New Insurance Paradigm Video