Claim Form Rule: Adding DRG Codes

  • Updated

What claim change is needed?

Add a DRG code to the UB-04 form.  DRG codes are the diagnosis-related group codes. Each DRG has a payment weight assigned to it. Payment weights are affected by factors such as:

  • geographic location (cost of living adjustment factor),
  • the number of low-income patients in that location (DSH adjustment),
  • whether that facility is a teaching facility (IME adjustment), and
  • if this is an outlier case (a particularly costly case).

Box Number

UB-04: Box 71 - PPS Code

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: DRG Code.
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  8. Then click Add.
  9. Input the DRG code.
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  10. At the bottom of the window, click the Create button.

 

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