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Charge Management Action Examples
Add a Legacy ID in HCFA Box 33b for a Secondary Payer Scenario: 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 ...
Charge Management Rule Examples
Alert for Provider Credentialing There is a System delivered Charge Management Rule to display a Validation Warning for Providers who are not yet Credentialed with a Specific Insurance. Use this link for more detailed documentation: Hold Billing for ...
Worklist Suggestions & Examples
Appointment Missed Appointment Fee: Added by Front Desk user for biller to add a No Show Fee. Workers Comp: Authorization missing Eligibility Denials Authorizations Encounters Manual Insurance Denials Eligibility Denials Authorizations Missing ...
Denial Worklist Overview
The Denial Worklist is populated when an ERA is applied, and at least one line item on the Remit has a zero dollar Payment and is statused to DW on the ERA Remit Items screen. The Worklist is interactive where the Encounter Dashboard, Patient ...
Rejections Examples
Rejection: Invalid Subscriber ID Format for ___ Resolution: From the Patient Dashboard, verify Eligibility, view the Eligibility Report, view the Patient's Scanned Insurance Card, and/or call the Patient. Correct the Policy Number. On the Encounter ...