Charge Management Action Examples
Add a Legacy ID in HCFA Box 33b for a Secondary Payer
- BCBSTX is Primary and MagnaCare is Secondary.
- MagnaCare wants a Legacy ID in Box 33b on the HCFA (Paper Claim), but the Primary, BCBSTX, does not require this.
Criteria
- Select Policy-Insurance (2) - ID > EQUALS > 109 (MagniCare ID)
- Encounter - Is Reversed > DOES NOT EQUAL > Yes
Actions
- Claim Insurance: Select the Insurance you want to change
- In this case, 109 (MagniCare)
- Select HCFA Legacy ID - 33B from the Field dropdown.
- Action: Select Replace on Claim.
- Value: Enter the Legacy ID that you want on the Secondary Paper Claim.
Test Validation Rule
- Before saving, Test the Rule to verify that the Action is working the way you intended.
- Select the Test All Encounters button.
- In the Will Trigger Validation panel, select one of the Encounter links to verify the action is working.
- Select Save [F2].
Validation Panel on the Encounter Dashboard
The Charge Management Action displays in the Validation Panel on the Encounter Dashboard.
Include Rendering in Loop 2420A
- If AETNAMCR is Primary or Secondary, the Rendering needs to be in Loop 2420A.
Criteria
- Policy-Insurance ID (1) > EQUALS > AETNAMCR
- Select the or link.
- Policy-Insurance ID (2) - EQUALS > AETNAMCR
Conditions
- Encounter - Is Reversed > DOES NOT EQUAL > Yes
Actions
- Claim Insurance: Select BCBSTX
- Select Include Rendering - ANSI 2420A from the Field dropdown.
- Action: Select Replace on Claim.
Test Validation Rule
- Before saving, Test the Rule to verify that the Action is working the way you intended.
- Select Save [F2].
Loop 2420A
Include Taxonomy in Loop 2000A
- If BCBSTX is Primary or Secondary, a different Taxonomy should be in Loop 2000A.
- Charge Entry Validation: Select None or Warning
- Warning will display a Validation Warning when the Encounter is saved.
- Batch Validation: Uncheck
- Validation Message: Enter the Message that the User will see.
Criteria
- Policy-Insurance ID (1) > EQUALS > BCBSTX
- Select or.
- Policy-Insurance ID (2) - EQUALS > BCBSTX
Conditions
- Procedure - DOS: > GREATER THAN OR EQUALS TO > 09/01/2024
Actions
- Claim Insurance: Select BCBSTX
- Select Taxonomy - ANSI 2000A from the Field dropdown.
- Action: Select Replace on Claim.
Test Validation Rule
- Before saving, Test the Rule to verify that the Action is working the way you intended.
- Select Save [F2].
Related Articles
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