The service name describes the revenue code from Box 42. Traditionally, the clearing house generates this information within the claim form. However, 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!
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- Navigate to Management Center > Claim Rules.
- Click Create Claim Form Rule.
- Select the Practice.
- Next, give the rule a name.
- Update the Claim Type to Institutional.
- Select Conditions to create criteria a claim should meet before the rule will apply.
- Next, click on the Behaviors dropdown.
- Select Claim Form Service Names.
- Next, click Add.
- Update the dropdown to one of the following choices:
- Require and Write to Claim to always require the claim form service name.
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User Clearinghouse Default Behavior to use the service name description generated by the clearinghouse.
- To create multiple behaviors, repeat steps 7-10.
- Click Save to complete the process.
- Navigate to Management Center > Claim Rules.
Box Number(s)
- UB-04: Box 43 - Revenue Code Description field
- CMS-1500: N/A
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.
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