Claim Form Rule: Managing Claim Form Service Names

  • Updated

What claim change is needed?

Choose which service name to use on claim forms.  The service name is the name that describes the revenue code from Box 42.  At times, payers require the description of the revenue code to accompany the code on the UB-04 form.  To add the service name, a claim form rule is created to write the description/name on the claim.

The clearinghouse uses default service descriptions based on HCPCS, but those can be overridden using the claim rule below.

Box Number

UB-04: Box 43 - Revenue Code Description field

Steps

  1. Navigate to Management Center > Claim Rules.
  2. Click Create Claim Form Rule.
  3. Select the Practice.
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  4. Name the claim rule.
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  5. Set Claim Type to Institutional depending upon service.
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  6. Set conditions for the claim rule to be met.
  7. Select the Available Behavior: Claim Form Service Names.
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  8. Then click Add.
  9. From the Select dropdown arrow, choose Require and Write to Claim.
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  10. At the bottom of the window, click the Create button.

Related Articles

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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