Claim Form Rule: Adding or Removing Patient Reason for Visit Code

  • Updated

What claim change is needed?

Adding or removing the patient's reason for visit code.

Box Number

UB-04: Box 70a-c - Patient Reason DX

CMS-1500: n/a

Steps

  1. Add or edit the first diagnosis code for a patient from Intake > Behavioral Service Diagnoses or Standalone Service Diagnoses.
  2. In Management Center > Claim Rules, select Create Claim Form Rule.
    mceclip0.png

  3. Select the practice that the claim rule will be applied to
    Screen_Shot_2020-09-14_at_20.49.32.png

  4. Select the conditions that will require the patient reason for visit code. Generally, we will see that the Current Sequence Behavioral Payer should be set to United Health Care and the Bill Type Prefix is set to 13, 85, or 78.
    Screen_Shot_2020-09-14_at_20.53.53.png

  5. Select the behavior to "Diagnosis - Patient Reason for Visit Code".
    Screen_Shot_2020-09-14_at_20.56.13.png

  6. When creating new claims, confirm the claim rule is working by clicking the View link next to the claim. Users should see Box 70a for Patient Reason for Visit 1 and the code.
    mceclip1.png

     

  7. Users can also look at the PDF by clicking the Preview link next to the claim to see Box 70 include the Patient Reason DX.
    Screen_Shot_2020-09-14_at_21.08.20.png

 

Related Articles

Claim Rule: UHC Rejection - Patient Reason For Visit Codes

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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