Billing provider
The provider or supplier identified as submitting the claim and requesting payment under the applicable billing arrangement.
Updated
The billing provider is the provider or supplier identified on a claim as the party submitting the bill and requesting payment. Its identifiers and enrollment relationship must fit the claim, rendering arrangement, location, payer, and program requirements.
The billing provider may be an individual or an organization and may differ from the rendering, referring, ordering, supervising, or service-facility roles represented on the same claim.
In practice
Maintain billing-provider name, NPI, taxonomy, address, tax, enrollment, and payer configuration in controlled master data. Do not substitute another provider merely to pass an edit.
Commonly confused with
- Rendering provider: The rendering provider identifies who performed the service; the billing provider submits the claim and requests payment under the billing arrangement.
- Submitter: The submitter transmits the electronic transaction and may be the provider, billing service, or clearinghouse rather than the billing provider itself.