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?

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 submit one line on a Claim (Partial Resubmission)

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?

How do I delete a Claims Batch?

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?

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.


Incident-To Billing

What is Incident-To Billing?

How do I do Incident-To Billing?

Insurance

How do I transfer/move a Charge/Encounter to another carrier/payer/insurance?

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?

For one Patient, look at the Encounter Dashboard Transactions to see if the Secondary has made a payment.
For multiple Patients, run the Custom Encounter Report.
  • 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.


How do I attach a Claim to a 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?

Void

How do I void a Claim?









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