Claim Form Rule - Set Bill Type Suffix to 1 for Admit through Discharge

  • Updated

What claim change is needed?

The Bill Type Suffix needs to be changed to 1 to indicate the claim is Admit through Discharge.

Note: AveaOffice is configured to determine if the Bill Type Suffix should be 2/3/4 based on the Admit date and Discharge date. 

How to create the rule

Let's review how to create the Claim Form Rule for Admit-through-Discharge claims.

  1. Navigate to the Management Center >Claim Rules and Select Create Claim Form Rule 
  2. Within the Claim Form Rule window, set the Conditions of each claim you would like the rule to apply to.
  3. After you have set the Conditions each claim should meet before applying the rule, under Available Behaviors, select Bill-Type Suffix then Add.
  4. In the dropdown, select the suffix to apply to the claim then scroll down and select Create
  5. If the treatment episode is not currently discharged, please add the following conditions:
  6. Once your conditions have been set, select Save
  7. Since the system will not generate corrections that only affect the suffix, the correction will need to be generated within the Patient Profile. 
  8. Navigate to the Patient Profile  > Treatment Episode > Insurance Billing > Claims and select Resubmit.
  9. 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.
  10. After selecting the Resubmission Issue, select Create to create the resubmission.
  11. 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: Avea does not currently support Admit-through Discharge claims with more than 1 Authorization number. If you have more than 1 Authorization Number or the rule is not applying, please reach out to support@aveasolutions.com for additional assistance.

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