This rule will add or remove the admitting diagnosis from a claim.
Workflow
Let's review how to create a claim rule to manage the admitting diagnosis on a claim!
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- Navigate to Management Center > Claim Rules.
- Click Create Claim Claim Form Rule.
- Select the Practice.
- Next, give the rule a name.
- Update the Claim Type to Institutional.
- Select Conditions to create criteria a claim should meet before the rule will apply.
- Next, click on the Behaviors dropdown.
- Select Patient - Admitting Diagnosis Code.
- Next, click Add.
- Update the dropdown to one of the following:
- Omit to remove the admitting diagnosis from the claim.
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Write to Claim to include the admitting diagnosis on the claim.
- To create multiple behaviors, repeat steps 7-10.
- Click Save to complete the process.
- Navigate to Management Center > Claim Rules.
Box Number(s)
- UB-04: Box 66 - Diagnosis and Procedure Code Qualifier
- 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.
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