Add or Remove Value Codes

A value code is a two-digit code used in institutional insurance claims. It provides specific information about the patient's insurance, service, or payment situation.

Workflow

Let's review how to create a claim rule to add or remove value codes to claims!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Claim Claim Form Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
  5. Update the Claim Type to Institutional.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, click on the Behaviors dropdown.
  8. Select the desired Value Code. 
     
  9. Next, click Add.
     
     • Update the dropdown to Write Billed Per-Unit Rate to instruct the system on how it should calculate the accompanying amount.
       
     • Update the dropdown to Set Rate Code To: to instruct the system on how it should calculate the accompanying amount.
       Select Write to Claim to instruct the system to calculate the accompanying amount using the facility rate.
       
     • Update the dropdown to Write Units Billed minus Units w/ Denied Auth
       
     • Update the dropdown to
       
     • Update the dropdown to
       
  10. To create multiple behaviors, repeat steps 7-10.
  11. Click Save to complete the process.
       

Box Number(s)

• UB-04: Box 39, 40, 41 - Value Code/Amount
• 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.