Medical billing - Account receivable specialist role

Provider Enrollment.
1.W9 Forms2.Provider Enrollment forms3.If non participating 4.Tax Identification number5.Provider number
The AR Rep should be aware in rough details the above-mentioned situations in order to effectively discuss with the carrier and get the Physician enrolled.

W9 Forms:

These are forms that are used by the Internal Revenue Service in the U.S.A, for maintaining the collections of the physicians therefore should the Insurance want proof of address, UPIN # etc they would normally ask

for the W9 forms so that they could update their records.

Provider Enrollment Forms

These forms would be given by the carrier which needs to be filled in correctly so that the Insurance could then update their records of who is the doctor/Provider his UPIN number his mailing address the location of his facility, and is he/she treating in more than one facility. All these details would be fed into their system to maintain accurate records.


In this scenario then the AR needs to identify if out-of-network benefits would be given to a particular patient under this Insurance in some cases the Insurance does not pay for out of network benefits, whereas in other instances there is a penalty of low reimbursement rate, and a slower processing time. Therefore these considerations need to be looked at critically in order to effectively coordinate the collection level.

Tax Identification Number.

If your practice is incorporated, your federal tax identification number (FEIN) belong to block 25 on the HCFA claim form, if you are not incorporated, the billing physician's Social Security number belongs in this block. Medicare uses this information to issue tax information to the IRS at the end of the year and to institute Medigap payment transfers. Omission of this information will cause a claim delay or denial. And, if you are participating and forget to complete this then Medigap payments will not be made to you.

Provider Number

Is a number given to a facility with a list of physicians listed under this number? This number must be linked to the Tax Identification number, otherwise the claim will be denied. Therefore the AR Rep needs to initiate action with the carrier to have these linked.
Note : This number is replace by NPI.

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