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Example 1
Dr Brown having a small Clinic Called GetWellSoon.
Patient John visiting the Dr Brown clinic for abdominal pain .
Dr Brown diagnose the problem and gives the Treatment;
The claim will be generated from Dr Brown office
| Who is the Rendering Provider ? | Dr Brown |
| Who is the Referring Provider ? | Not applicable |
| Which is the Facility ? | GetWellSoon It is also called as Location or Place of Service |
| Who is the Billing Provider ? | Dr Brown |
| Who is the Patient ? | John |
| Which is ICD Here ? | Each Disease represents by a Code. That code is called ICD. It is also called Dx Codes or Problems or ICD Codes or Diagnosis Codes. In this example, abdominal pain is the disease and ICD Code assigned is R10.10 |
| Which is CPT Here ? | Treatment given by the doctor. Each treatment represent a code and that code is called CPT. It is also called Procedure. |
Example 2
Dr Brown having a small Clinic Called GetWellSoon.
Patient John visiting the Dr Brown clinic for abdominal pain .
Dr Brown checks and ask the Meet the Specialist called Dr Joe who is having a clinic name called GoodHealthClinic
Claim will be generated from Dr Joe Office
| Who is the Rendering Provider ? | Dr Joe |
| Who is the Referring Provider ? | Dr Brown |
| Which is the Facility ? | GoodHealthClinic It is also called as Location or Place of Service |
| Who is the Billing Provider ? | Dr Joe |
| Who is the Patient ? | John |
| Which is ICD Here ? | Each Disease represents by a Code. That code is called ICD. It is also called Dx Codes or Problems or ICD Codes or Diagnosis Codes. In this example, abdominal pain is the disease and ICD Code assigned is R10.10 |
| Which is CPT Here ? | Treatment given by the doctor. Each treatment represent a code and that code is called CPT. It is also called Procedure. |
Example 3
Dr Brown having a small Clinic Called GetWellSoon.
Patient John visiting the Dr Brown clinic for abdominal pain .
Dr Brown checks and ask John to take some lab test and he recommend the Lab called Century to do some test
Claim will be generated from Century Lab
| Who is the Rendering Provider ? | Lab (Because Lab does the service to the Patient) |
| Who is the Referring Provider ? | Dr Brown. It is also called Ordered Provider (The Provider who actually order the test for this patient) |
| Which is the Facility ? | Lab (In the Lab only, the test is conducted) . It is also called as Location or Place of Service |
| Who is the Billing Provider ? | Lab (Lab Need to get paid for performing test/exams on patient ) |
| Who is the Patient ? | John |
| Which is ICD Here ? | Each Disease represents by a Code. That code is called ICD. It is also called Dx Codes or Problems or ICD Codes or Diagnosis Codes. In this example, abdominal pain is the disease and ICD Code assigned is R10.10 |
| Which is CPT Here ? | Treatment given by the doctor. Each treatment represent a code and that code is called CPT. It is also called Procedure. |
Example 4
Assume that GreenPoint Healthcare is a Medical Management Companies and owns lot of small clinics and Hospital Under different name;
Assume that MyGoodHealth clinic is under them and Dr Alex is working for that clinic;
Patient John visiting MyGoodHealth clinic for abdominal pain .
Dr Alex checks and gives the Treatment;
Claim will be generated from GreenPoint Healthcare Office or MyGoodHealth Clinic
| Who is the Rendering Provider ? | Dr Alex |
| Who is the Referring Provider ? | Not Applicable |
| Which is the Facility ? | MyGoodHealth . It is also called as Location or Place of Service |
| Who is the Billing Provider ? | GreenPoint Healthcare |
| Who is the Patient ? | John |
| Which is ICD Here ? | Each Disease represents by a Code. That code is called ICD. It is also called Dx Codes or Problems or ICD Codes or Diagnosis Codes. In this example, abdominal pain is the disease and ICD Code assigned is R10.10 |
| Which is CPT Here ? | Treatment given by the doctor. Each treatment represent a code and that code is called CPT. It is also called Procedure. |