Claim Form Rule - Add Occurrence Codes to Institutional Claims

  • Updated

What claim change is needed?

Adding or removing occurrence codes on institutional claims. Workers comp claims can require the Occurrence Code and a related Date to be added to the claim. The Occurrence Code and Occurance Code Date are added to the patient's treatment episode (and can be edited under the Admit/Discharge tab) but require a claim form rule to pull the code and date onto the claim. mceclip0.png

Box Number

Rule Creation Steps

  1. Open the Management Center > Claim Rules. mceclip1.png

  2. Click Create Claim Form Rule.

  3. Select the Practice.mceclip7.png
  4. Name the rule.mceclip8.png
  5. Choose Institutional from the drop-down. This won't apply to professional claims.mceclip9.png
  6. In the Conditions section, select the desired Payer Type (Behavioral, Home Plan, Medical) and Position (Primary or Sequence) depending on which payer requires the addition of the Occurrence Codes. For this example, we selected the Primary Behavioral Payers option and chose the payer that required the Occurrence Code and Date to be added to the claim. mceclip6.png
  7. From the Available Behaviors section, select Occurrence Code from the drop-down.mceclip3.png
  8. Click Add. mceclip4.png
  9. From the drop-down choose Require and Write to Claim to include the code and date on the claim form.mceclip5.png
  10. Review the configuration, then click Create to save. mceclip10.png

Now, when a claim meets the Occurrence Code rule conditions:

  • The Occurrence Code Date and Cccurrence Code will be added to institutional claims (pulled from the Admit/Discharge tab of the Treatment Episode). 
  • The Occurrence and Code Occurrence Code Date will be added to the form contents view (in the EDI section)
  • The Occurrence Code and Occurrence Code Date will be added to the Claim Form Preview in Box 31a.

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