Set Claim Type To

Some payers may require a different claim type than what you normally send. For example, Beacon Health might want to see Drug Screening services on professional forms, while BCBS wants to see them on institutional forms. Set up the service billing profile to the default claim type that you'll send to most payers, then set up a service grouping rule to send the other claim form type to the other payers.

Workflow

Let's review how to create a claim rule to update the claim type!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Service Grouping Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
     
  5. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  6. Under Service, update the dropdown with the service you want the rule to apply to.
     
  7. Next, under Set Values, click Set Claim Type to.
  8. Update the dropdown to the desired claim type.
     
  9. Click Save to complete the process.
      

Helpful Hints

• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.
• To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.