Charge Management Actions Examples

Charge Management Actions 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, the Rendering should be in Loop 2420A.
  • 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 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].





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