The following definitions apply to terms used in the Professional Claim.
The Referring Provider is the individual who directed the patient for care to the provider rendering the services being reported.
Examples include, but are not limited to, primary care provider referring to a specialist; orthodontist referring to an oral and maxillofacial surgeon; physician referring to a physical therapist; provider referring to a home health agency.
The Ordering Provider is the individual who requested the services or items being reported on this service line.
Examples include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies.
The Rendering Provider is the person or company (laboratory or other facility) who rendered the care. In the case where a substitute provider (locum tenens) was used, enter that provider's information here.
Future Versions of 837P
The Rendering Provider is the individual who provided the care. In the case where a substitute provider (locum tenens) was used, that individual is considered the Rendering Provider.
The Rendering Provider does not include individuals performing services in support roles, such as lab technicians or radiology technicians.
The Supervising Provider is the individual who provided oversight of the Rendering Provider and the care being reported.
An example includes, but is not limited to, supervision of a resident physician.
Purchased Service Provider
A Purchased Service Provider is an individual or entity that performs a service on a contractual or reassignment basis for a separate provider who is billing for the service.
Examples of services include, but are not limited to: (a) processing a laboratory specimen; (b) grinding eyeglass lenses to the specifications of the Rendering Provider; or (c) performing diagnostic testing services (excluding clinical laboratory testing) subject to Medicare’s anti-markup rule. In the case where a substitute provider (a locum tenens physician) is used, that individual is not considered a Purchased Service Provider.
An individual who has received, is receiving, or intends to receive health care services. (Health care services as defined by federal and state regulations.)
An individual who has insurance coverage under the policy of another individual.
An individual or entity that is the holder of an insurance policy (including health, property and casualty, auto, workers’ compensation, or other liability) for the purposes of health care services.
An individual or entity that has insurance coverage.