Effective April 1, 2020, claims submitted to ProviDRs Care will be rejected as unprocessable if the rendering provider information is not completed in Box 31 and Item 24J of the CMS 1500 Claim Form. These areas are highlighted in the below claim form.
Item 24J
Enter the rendering provider or supplier National Provider Identification (NPI) number. If services were rendered by a provider, please ensure the NPI of the rendering provider is entered and not the NPI of the provider group.
Box 31
Enter the name of the rendering provider of service or supplier and date the form was signed. Claims ARE processed in or out of network based on the information provided in box 31 and Tax ID in box 25.
Box 33
Box 33 is used to indicate the name and address of the Billing Provider that is requesting to be paid for the services rendered. Claims are NOT processed in or out of network based on the information provided in box 33.
If you have questions, please contact Provider Relations by calling 800-801-9772, option 4, option 3 or email ProviderRelations@ProviDRsCare.net.