Add or Remove Claim Form Service Names

The service name describes the revenue code from Box 42. Since this information is not inherently included on institutional claims, this rule instructs the system to use (or omit) the Claim Form Service Name located in the service billing profile. 

Workflow

Let's review how to create a claim rule to include the service name in box 43 of an institutional claim!

1. Navigate to Management Center > Claim Rules.
2. Click Create Claim Form Rule.
3. Select the Practice from the drop-down.
   
4. Next, give the rule a name.
5. Leave the Claim Type field as Institutional and change the order of the rule when applicable.
6. Then select Conditions to create criteria a claim should meet before the rule will apply.
7. Next, click on the Behaviors drop-down, select Claim Form Services Name, then click Add.
8. Update the drop-down to one of the following choices:
   1. Require and Write to Claim to always require the claim form service name. 
   2. User Clearinghouse Default Behavior to use the service name description generated by the clearinghouse. 
      
9. To create multiple behaviors, repeat steps 7 and 8.
10. Click Save to complete the process.
     

Box Number(s)

• UB-04: Box 43 - Revenue Code Description field
• CMS-1500: N/A

Frequently Asked Questions and Helpful Hints

Let's review some helpful hints and some more commonly asked questions!

Frequently Asked Questions

• The best way to determine if a scheduled change set is appropriate is to gauge how many claims will be affected. For example, if you want the rule to apply to previously billed claims as well as new claims going forward, create the rule without a scheduled change set. 
  
  However, if you want the rule to apply only to newly created claims, use a scheduled change set to instruct the system to look only for claims with dates of service on or after the set date. For more information on scheduled change sets, click here.
• If you are creating the rule to apply to previously billed claims, navigate to the Patient > Treatment Episode > Claims > Review Corrections section and click Check For Corrections. If corrections are generated, follow the process outlined here to complete the process. If no claims are flagged for rejection, click here to troubleshoot the rule why the rule may not be applying.

Helpful Hints

If one of your conditions is payer-based, select any applicable Current Sequence options 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.