Correction Troubleshooting

  • Updated

If the desired corrections are not populating, or are not generating as desired, run through the following steps.

  1. Run through the steps to generate the correction again. Verify that everything was completed correctly and no steps were missed.
  2. Check the Corrections History for corrections that were ignored previously. 
    • This is where corrections go when the Ignore radio button is selected on the Select Correction Action form.
    • You can View and Update corrections from this tab.
  3. Check the patient's other Treatment Episodes. If the patient has multiple treatment episodes, the corrections may be in a different episode than the one you're currently viewing.
  4. Ensure that changes were made to the correct Practice or all applicable Practices. Example: Detox billing profiles were edited under ABC Treatment Center, but the same changes were not made under 123 Treatment Center.
  5. Ensure that the claim is associated with the edited UR plan or attendance record. Example: Edits were made for the UR plan from 4/10/18 to 4/15/18 but the claim is associated with the 4/16 to 4/20/18 UR plan.
  6. Ensure that Effective Dates and Scheduled Change Sets encompass the dates of service on the claim. Example: If a claim rule has a scheduled change set to become active on 2/15/23 and the claim has a date of service of 2/10/23. The claim rule will not impact the claim. Backdate the rule so it is active on or before the date of service on the claim.
  7. Pay attention to similarly named Services and Billing Profiles. Example: Changes were made to the service, Family Therapy w/out Patient but the service on the claim is Family Therapy w/ Patient. Corrections would not prompt for the service, because no changes were made to the service.
  8. Ensure that the service is referenced in the Facility in Practice Admin > Facilities.
  9. If the service needs to go out as professional make sure there is a Professional Service Line and a Professional Unit Rate.
  10. Check the Claim Rules. If there are conflicting changes, claim rules will override other settings. Example: The service billing profile in the patient’s UR tab dictates that the claim should go out as professional. There is a claim rule to set the claim type to Institutional. The claim rule will take precedent and the claim will go out as institutional.
  11. If using claim rules, ensure that all conditions are met by the claim that needs corrections.

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