FAQs

How does SolAce handle provider ID numbers? SolAce supports multiple payers and communication channels, and payers have differing requirements on the Provider ID numbers (PINs) and NPIs that need to be used on their claims. To accomodate all the different requirements, SolAce has built-in support for very complex provider setups. SolAce tries to present this in a very user-friendly way so that providers with simple setups aren't overwhelmed, but providers with complex setups are not limited by the software. For starters, SolAce requires setup of a provider list. There are multiple reasons for this, most important among them to be able to provide good edit checks for new electronic claim billers, and to support the provider data requirements of the HIPAA 837 transactions. Provider Types Each provider in the SolAce provider list has an entry type that is easy to understand, but tells SolAce an important piece of information about how the PINs and NPIs for that provider can be used. The table below shows the provider entry types along with the information that SolAce gets from that entry type.

Provider Type	Valid as a Billing Provider	Valid as a Rendering Provider	Notes
Solo Practice/Organization
Group Practice			Will have no UPIN or taxonomy code. Used for Facilities also.
Group Provider			Will have no address, and will always reference a billing provider (a Group Practice) for name, address and Tax ID.

General PINs Each provider in the SolAce provider list has a Tax ID or SSN. Group Providers have an SSN but it is never transmitted and is only used in rare cases for matching an SSN on a claim form to an entry in the SolAce provider list. Each provider also has a list of General PINs, which are provider ID numbers based on a payer's Plan Type (also known as "line of business"). Examples of General PINs are Medicare PIN, Medicaid PIN, and BCBS PIN. Plan Type corresponds to payers because each payer in the SolAce payer list has a Plan Type. SolAce determines which PIN to use for an individual claim by looking at the payer and provider number on that claim. For a Medicaid claim it will try to locate a provider with the Medicaid PIN on your claim. If there is no matching PIN for the payer a match will be attempted based on Tax ID. As an example of how this works, assume you have a claim imported into SolAce with the payer identified as Virginia Medicaid and a PIN in box 33 of 12345. Virginia Medicaid's entry in the SolAce payer list indicates that the Plan Type is Medicaid. In this example, SolAce will try to locate a provider entry with a Medicaid PIN of 12345. Once located, the provider entry tells SolAce everything it needs to know for edit checks and transmission. If no PINs are provided, SolAce will search based on NPI and/or Name. There are always exceptions, and for everything we have covered up to this point there is a way to override the default behavior. PIN Overrides The PIN Overrides feature in SolAce is where the ultimate in PIN flexibility resides. This feature lets you build a list of payer-specific provider ID numbers. PIN Overrides take precedence over the General PINs we just covered. To add a PIN Override you select the payer and enter the PIN that should be submitted for that payer. The PIN Overrides list is checked before the General PINs or Tax ID, both during editing and transmission. This allows you to print one PIN on your claim form and set it up in the General PINs area, but override it for electronic claims by adding an entry to the PIN Overrides list. In addition, you can override whether the PIN is valid for use as a billing or rendering provider number. Remember what we covered in the Provider Types section above about the different provider types being valid for billing or rendering usage? The PIN Overrides feature lets you override this default behavior for individual payers to allow use of a PIN as billing or rendering. SolAce also tries to default this sensibly, such as allowing Group Practices to be used as Rendering providers on commercial claims. Scenarios Some of the more complex scenarios are described below with a description on how SolAce would be setup to handle the situation. Keep in mind that each scenario might be payer-specific, and SolAce can handle each scenario separately by payer. In other words, you might have one scenario that applies to Medicare, and another that applies to Medicaid. You would just combine the different setup techniques described below to handle all your payer's requirements.

Scenario	Provider Setup
Group number for the office and individual numbers for each physician. In 1500 form terms this would be your office name and group PIN in box 33, and individual name and PIN in box 31 and 24J respectively.	Add the office as a Group Practice, then the individuals as Group Providers. Enter the Medicare Group ID in the Group Practice's Medicare PIN field, and the Medicare PINs in the individual providers' Medicare PIN field. For Noridian submitters, use the PIN Overrides feature to supply a different PIN for electronic claims than you would typically use for paper claims.
Billing provider is a company, but the individual providers don't have PINs and get billed using a company PIN for all or most of the providers. In 1500 form terms this would be your office name and PIN in box 33, and an individual's name in box 31. This is a common setup for commercial payers where the Tax ID is used as the PIN.	Add the company as a Group Practice. Go to the PIN Overrides feature for the Group Practice and add a payer-specific PIN with the Rendering checkbox marked to indicate the group PIN can be used for the rendering provider ID. Be certain to map the RENDERING-NAME field to box 31 or 33 in your map because SolAce will not be able to pull the name from the provider list in this case. If there are also individuals in the mix that have specific PINs for themselves, then add those individuals as Group Providers related to the Group Practice. Enter general or payer-specific PINs for these individuals and it will be used with the Group Practice PIN on the claim.
Billing provider is a company, but some individual providers have PINs and should be billed as the billing provider. In 1500 form terms this would be the physician's name and PIN in box 33, even though they are part of a larger group of doctors.	Add the company as a Group Practice, then the individuals as Group Providers. Use the PIN Overrides feature to enter the PINs on the Group Provider entries, and mark the Billing checkbox to indicate the individual PIN can be used for the billing provider ID. If you also have a PIN at the Group Practice level it will only be used for Group Providers that have PINs without the Billing checkbox marked. The Group Practice information is still used for Address, Contact Person, and Tax ID.