Configuring Your Organization's Claims Settings
Written by David Mamae
Updated at March 1st, 2025
Table of Contents
Claim Settings in Pear Suite
Setting up claims settings in Pear Suite ensures that billing processes run smoothly and claims are submitted accurately. This includes managing Billing Providers, Rendering Providers, and Recommending Providers, enabling billing features, and defining claim configurations for different payers.
These settings can be configured in Organization in the side menu under the Claims tab.
(Click on image to enlarge)
Configuring claims settings allows you to:
- Enable Billing to allow claim submission.
- Assign Billing Providers responsible for submitting claims.
- Define Rendering Providers as the individuals or entities providing the service.
- Set up Recommending Providers to submit recommendations for CHW services when required by payers.
- Establish Claim Configurations with default procedure codes and modifiers.
Enabling Billing, Recommending Providers & Consent Templates
Selecting Enable Billing activates billing features, allowing you to generate and submit claims. Selecting Enable Recommending Providers allows designated providers to recommend billable services when required by payers.
- Enable Billing – Turns on billing features, ensuring that billable activities can generate claims for submission.
- Enable Recommending Providers – Grants designated providers the ability to recommend services that require payer approval.
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Consent Templates – Defines the type of member consent required before claims can be submitted. Options include:
- CHW Attestation – Ability to use a recorded line to capture verbal consent from the member, allowing Community Health Workers (CHWs) to confirm the member's agreement to receive services.
- Written Consent – Requires the member to sign a physical or digital consent form.
- Billing Consent (In Person) – Captures consent obtained directly from the member in a face-to-face interaction.
- Billing Consent (Call Recording) – Documents consent given during a phone call via recorded verification.
- Consent to Enroll in ECM Services – Specifies that the member has agreed to enroll in Enhanced Care Management (ECM) services.
Managing Billing Providers, Rendering Providers, and Recommending Providers
Managing Billing Providers, Rendering Providers, and Recommending Providers ensures that claims are submitted under the correct entities and meet payer requirements.
- Billing Providers – The organization or individual responsible for submitting claims and receiving payments. Each claim must be associated with a Billing Provider to be processed.
- Rendering Providers – The individual or entity providing the service. This must be accurately recorded for claims to be approved.
- Recommending Providers –The individual who submits a recommendation confirming that the member meets the eligibility criteria for CHW services.
Billing Providers
Billing Providers lists providers responsible for submitting claims, with options to add or update them.
Click here to learn more about Billing Providers.
Rendering Provider Details
The Rendering Provider Details section stores key information about the provider responsible for delivering services. You can enter the Tax Identification Number (TIN), National Provider Identifier (NPI), and contact details. This information ensures that claims are correctly attributed to the appropriate provider.
Recommending Providers
Some payers require a licensed provider to submit a recommendation before CHW services can be billed. The recommendation confirms that the member meets the eligibility criteria for CHW services but does not require the provider to be part of the payer’s network.
Setting Up Claim Configurations
Defining Claim Configurations ensures that the necessary billing details are automatically applied when generating a claim. This includes:
- Procedure Codes and Modifiers – Default codes applied to specific billable services.
- Unit Costs – The amount billed per service unit.
- Rendering Providers – The designated provider performing the service.
- Recommendations – Whether a Recommending Provider is required for specific services.
Claim Configurations
Each insurance provider will have unique billing requirements. Claims Configuration allows you to define how claims are processed for different payers. You can set up Procedure Codes, Modifiers, Description, Units, Unit Length, and Unit Cost to ensure claims are submitted correctly. The Rendering Provider column indicates which provider is associated with the claim, and the Recommendation column determines whether a provider recommendation is required.
