Changing Place of Service on Professional Claims

  • Updated

Place of Service codes on Professional Claims indicates where a service was provided. Changing these codes is appropriate when a payer has specifications about what they accept, or if the provider changes their location.  

Changing Place of Service - Billing Profiles  

To update the Place of Service on the Billing Profile, navigate to Practice Admin, open the Services tab then select the service.

  1. Once in the service, open the Billing Profile tab. 
  2. Change the place of service on a Billing Profile if the desired changes are applicable to all claims covered by that billing profile.
  3. Open the Profile, and choose to Create a Scheduled Change Set or edit the Baseline.
    • All Existing Claims: If you need to make a change that will impact all existing claims click the Edit icon and make updates to the Baseline. This is useful in situations where all or most claims need to go out with the new place of service. 
    • If the change is only needed back to a certain date or for all future claims, make a Scheduled Change Set for the desired effective date.
    • Edit by clicking the pencil icon, then select the appropriate Place of Service from the Professional Place of Service option.  
  4. Alternatively, you can add a new Service Billing Profile if the changes were on a smaller scale, for one or a few payers. For help creating a new Billing Profile, click here

Changing Place of Service - Claim Rules 

The Place of Service can also be changed by creating a Claim Rule. This method is fitting if there are certain conditions you want to trigger the use of a specific place of service.  

If you need more help creating Place of Service rules, click here.

  1. To edit claim rules, navigate to the Management Center then choose Claim Rules. 
  2. Rules that prompt setting a place of service will be configured under Create Service Grouping Rule
  3. Select the Conditions that need to prompt a change in the place of service.
  4. From the Set Values menu choose the option to set the place of service. 
  5. Select the desired place of service from the drop-down menu.
  6. Save the rule by clicking Create 

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