Facilities such as hospitals, critical care facilities, skilled nursing homes, home health agencies, and hospice providers bill as institutional providers when they provide services to Medicare beneficiaries.
These providers can bill through DrChrono, however, their account needs to be turned on for institutional billing.
- Check "Enable Institutional Claim" under Doctor Settings if only one provider will be billing as an institutional provider. Otherwise, you can enable institutional claims for the entire PG by enabling the same option under PG Settings.
Differences in Institutional Billing
- Claims are billed on a UB-04/HCFA-1450 form for institutional providers versus an HCFA-1500 form for professional providers.
- The electronic EDI file name for institutional claims is 837i vs. 837p for professional providers.
- There can be differences in payer IDs between institutional claims and provider professional claims.
- TriZetto Institutional Provider Payer List
- TriZetto Professional Provider Payer List
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Change Healthcare Payer List
- Change Healthcare has its lists under 1 heading. Under "Line of Business" you have a choice of Hospital (Institutional) or Medical (Professional) to get the appropriate list.
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Carisk Partners (fka iHCFA) Payer List
- Carisk lists payer ids under the headers Institutional and Professional.
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ePS Payer List
- One big difference with ePS is that claims are batched per provider and not in one giant claim file that is sent to TriZetto & Change currently. That way, if there is an issue with a file, it impacts only one client.
- Institutional and professional claims are batched separately in DrChrono and submitted to the clearinghouse at different times. All still go at least once a day, but for TriZetto, we submit 2 professional claim files per day but only 1 institutional claim file. Claim files for ePS (professional & institutional) are sent twice per day.
Differences in the Live Claims Feed
- When institutional claims are enabled for a provider, they will see a toggle switch appear within the account. It's on the top left inside of a patient's appointment within the Live Claims Feed. Once they enable it, additional institutional billing-only required fields will appear.
A set of 5 tabs will open on the right side of the screen within the institutional claim. Details on each of the fields that will populate each field on the UB04 claim form can be found here.