Box Definition
Box 4 on the UB-04 claim form is intended to display the type of bill to the payer for claim processing.
- First Digit = Leading zero. Ignored by CMS
- Second Digit = Type of facility
- Third Digit = Type of care
- Fourth Digit = Sequence of this bill in this episode of care. Referred to as a "frequency" code.
In AveaOffice
Let's review how to update the Second and Third digit of the Bill Type also known as the Bill Type Prefix on Institutional Claims.
- Navigate to Practice Admin > Service and select the Service you wish to update.
- Within the Service Profile, select the Billing Profiles subtab to display Billing Profiles associated with the Service.
- Tip: To see what Billing Profile was used during the Claim Creation, navigate to the Patient Profile > Treatment Episode > UR > Attendance History.
- To update some claims based on Date of Service, select the Create Scheduled Change Set icon and set the Effective Date.
- Once you have selected an Effective Date, select Save and allow the system to refresh.
- Locate and select the Pencil icon next to the Scheduled Change Set.
- In the Edit window, update the Institutional Bill Type Prefix and scroll to the bottom to Save.
- To update all Claims submitted with the existing bill type, select the Pencil icon at the Baseline and repeat the process from Step 4.
- Follow the Corrections process to update the affected claims.
Updating Bill Type suffixes.
Let's review how the system determines the Bill Type suffix and how to update it.
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- Suffix 1 indicates the Dates of Service on the Claim encompass the entirety of the patient stay known as Admit-through-Discharge.
- Suffix 2/3/4 indicates the claim is the Interim-:First Claim, Continuing Claim, or Last Claim.
- Suffix 7 indicates the claim is a resubmission with updated information (i.e. a Correction.)
- Suffix 8 indicates the claim is now Voided.
- To update the Suffix to 1, 2, 3, or 4, navigate to the Management Center > Claim Rules and select Create Claim Form Rule.
- Select the Conditions a claim needs to meet before the rule can be applied.
- Under Behaviors, select Bill-Type Suffix then Add.
- In the dropdown, select the suffix to apply to the claim then scroll down and select Create.
- Since the system will not generate corrections that only affect the suffix, the correction will need to be generated within the Patient Profile.
- Navigate to the Patient Profile > Treatment Episode > Insurance Billing > Claims and select Resubmit.
- In the Create Claim Resubmission Window, toggle the Submit as New Claim switch to tell the system to update the Bill Type Suffix and bypass the Internalized Control Number requirement.
- After selecting the Resubmission Issue, select Create to create the resubmission.
- To confirm the rule applied as desired, navigate to Work Center > Insurance Claims > Submit Claims and select View to confirm the correct Bill Type Suffix applied before select Submit.
- Note: AveaOffice does not currently support Admit-through Discharge claims with more than 1 Authorization number. Please reach out to the Support@Aveasolutions.com for additional assistance.
EDI Loop/Segment
Loop 2300, Segment CLM05-1 & CLM05-3
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