Charge/Claim FAQs

Charge/Claim FAQs

Charge/Claim FAQs

Attachments

How do I indicate there is attached paperwork?


Attending

What is an Attending Physician?

  • An Attending Physician is the one who is responsible for the overall care of a Patient in a hospital or clinical setting.

When is the Attending Physician used?

  • The Attending Physician is required on Institutional Claims.
  • Box 76 on the paper UB; Loop 2310A on the ANSI.


Charges

What is an Incomplete Charge?

 How Do I add a Diagnosis or a CPT to a Charge/Claim? 


Charge Template

How can I set up a Charge Template that I can use over and over?

Charge Template for Capitation/Bonus/Incentive Posting


Claim Status

How do I customize the Encounter by Status Panel?

How do I add a Custom Claim Status?

How do I handle Capitation/Bonus/Incentive Posting?


Claim Submission

How can I tell if a Claim has been submitted?

How do I resubmit a claim?

How do I resubmit a corrected Claim?

How do I resubmit a Partial Claim?

How do I send a corrected Claim for Frequency Rejection?

How do I resubmit a Fully-Paid Claim to a new Primary Insurance?

How do I resubmit a Claim with a Zero Balance to a Different Payer?


Claims Batch

How do I delete a Claims Batch?

  • A Claims Batch cannot be deleted if it has already been uploaded.
  • If the Claims Batch has not been uploaded, it can be deleted by a User who has Admin permissions.


CLIA

Where does the CLIA number go?


Copy

Can I copy a previous charge's information?


Crossed from Primary (EPX) Claims

How to I manage Crossed from Primary (EPX) Claims?


Dates

Post Date: What determines the Post Date?

How can I post for a future date?

 

Delete

How do I delete an Incomplete Charge/Encounter?


Denials and Rejections

What is the difference between a Denial and Rejection?

  • A Denial often occurs with an adjudication of the Claim.
    • Denials are received from the Payer on the EOB.
    • Denials can be partial or full.
  • A Rejection occurs before the Claim is adjudicated.
    • Rejections are received from the Clearinghouse, or from the Payer before adjudication.
      • The Payer will not have a record of the Claim.

DME

Where do I send DME Claims?


Duplicate

Is a Claim really a Duplicate?


Encounters

How do I delete an encounter entered in error?

How can I correct an encounter that is in a closed period?

What is the difference between reversing for modification and reversing for deletion?


Fees

Does the Charge Fee on an Encounter change by changing the Insurance Profile?

Yes:

  • If the Primary Insurance is linked to a different Charge Fee Schedule where the Fee is different; and
  • If the Insurance Profile is being changed on the Modify Encounter screen.
  • You have the option to decline the Fee change.
  • If this is being done in a Closed Period, a Reversal will be created with a new Encounter that has the same Encounter number as the original.

No:

  • If the Insurance Profile is being changed in any area other than the Modify Encounter screen, the Charge Fee will not change.

How do I find a Fee for a Procedure Code (CPT®)?

  • Go to the Procedure Code Library and enter the CPT® Code and select Search.
  • Go to the Fee/RVU Management Library and Filter to see all Fee Schedules that have a specific CPT® code and the Fees.
  • Enter the Procedure Code.
  • Type: Select Charge Fees from the dropdown.
  • Select the Billing Provider, Facility, and Insurance, if applicable.


Incident-To Billing

What is Incident-To Billing?

How do I do Incident-To Billing?


Insurance/Payer

How do I move a Charge/Encounter to a different Insurance/Payer?


NDC Numbers

What if I get a rejection for an Invalid NDC Number?


NPI

Why is the NPI required on the Facility?

  • The NPI is only required when the POS = 11.


Paper Claims

How do I force a Claim to paper?

How do I print paper Claims?


Payment

How do I know if the Secondary Insurance is Paying?

  • This report can be run by a specific Payer or across all Secondary Insurances.
  • Filter Policy-Insurance(2) - ID: Does not Equal > leave the field blank to pull all secondary payers.


Procedure Codes

Where is the Procedure Code Library?

How do I delete a Procedure Code from a Charge?


Provider Credentials

What is an NPP vs Mid-Level


Reference Batch

Why am I getting this Validation Error: You must be attached to a Reference Batch?

  1. This Validation Error means you are not currently attached to an Open Reference Batch.
  • Another User might close a Reference Batch that you are using.
  • In the upper right corner, select the Reference Batch link.
  • Open and Attach to the Reference Batch.
  1. If you forgot to attach to a Reference Batch, you can Open and Attach to an existing Reference Batch or create a new Reference Batch and attach to it.
  2. If the Claim is already in another Reference Batch, it can be moved to the correct Reference Batch.

Why aren't my Incomplete Charges attaching to a Reference Batch?

  • The System Setting DETACHINC must be set to No for Incomplete Charges to attach to the Reference Batch.


Rendering/Facility

Hierarchy of Auto-Population of the Rendering Provider on the Charge

Hierarchy of Auto-Population of the Facility on the Charge


Timely Filing

How do I prove Timely Filing?


Unbalanced Claims

  1. Payments and Adjustments do not equal Charge.

Void

How do I void a Claim?


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