Charge/Claim FAQs
Attachments
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
How Do I add a Diagnosis or a CPT to a Charge/Claim?
Charge Template
Claim Status
Claim Submission
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
Copy
Crossed from Primary (EPX) Claims
Dates
Delete
How do I delete an Incomplete Charge/Encounter?
DME
Duplicate
Encounters
What is the difference between reversing for modification and reversing for deletion?
Fees
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
Insurance/Payer
NDC Numbers
NPI
Why is the NPI required on the Facility?
- The NPI is only required when the POS = 11.
Paper Claims
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
Provider Credentials
Reference Batch
Why am I getting this Validation Error: You must be attached to a Reference Batch?
- 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.
- 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.
- 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
Timely Filing
Unbalanced Claims
- Payments and Adjustments do not equal Charge.
Void