Add or Remove the Patient Admit Type

This rule can add or remove the patient admit type from institutional claims. 

Workflow

Let's review how to create a claim rule to manage the patient admit type on institutional claims!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create 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 Patient - Admit Type.
     
  9. Next, click Add.
     
  10. Update the dropdown to one of the following:
      1. Omit to remove the admit type from the claim. 
      2. Write to Claim to include the admit type when creating the claim.
  11. To create multiple behaviors, repeat steps 7-10.
  12. Click Save to complete the process.
       

Box Number(s)

• UB-04: Box 14 - Admission Type
• 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.