What claim change is needed?
To add additional details or information on the UB-04 claim to help the payer interpret what action was completed during the patients' encounter.
- Navigate to Management Center > Claim Rules
- Click "Create Claim Form Rule".
- Select the Practice.
- Name the claim rule.
- Set Claim Type to Institutional.
- Set conditions for the claim rule to be met.
Typically, this is a payer requirement so you'll select the appropriate payer type (i.e. Primary Behavioral Payer).
- Select the Available Behavior: Remarks.
- Then click Add.
- Choose which option fits the behavior: if the payer requires additional remarks, select the option: Require and write to Claim; if the remarks are available, but not a requirement, then write the remarks to the claim.
- At the bottom of the window, click the Create button.
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.