Service Grouping Rule - Adding Patient Condition Codes

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What claim change is needed?

Add patient condition codes to an institutional claim form. To read about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article. 

Box Number

UB-04: Box 18-28 - Condition Codes

CMS-1500: n/a

Steps

  1. Navigate to Management Center click on Claim Rules.
  2. Select the Practice from the dropdown menu.
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  3. Click Create Service Grouping Rule.
  4. Name the rule.
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  5. Select the service.
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  6. Under Conditions, check the appropriate conditions needed for this billing scenario (i.e. Primary Behavioral Payer, Bill Type, etc)
  7. Select the option under Behaviors to Set Values.
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  8. Select Condition Codes.
  9. Add Condition Code.
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  10. Ensure that Is Active is set to Yes.
  11. Click Create.

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