If the UR plan has incorrect information but the correct options already exist in the system (like for example, the wrong rendering provider was selected but the correct rendering provider already exists), you can make the corrections directly from the UR plan. Changes that can be made directly to the UR plan include Facility, Service, Service Billing Profile, Rendering Provider, Billing Provider, Authorized Status, or Authorization Number.
Example: The practice was chosen as the billing provider, but the service was truly billed by the rendering provider.
Note: Changes made to a UR plan will impact all claims billed out using that UR plan.
Update UR Plan Information
Let's review how to update the patient's UR plan and submit corrected claims.
- Navigate to the patient’s Treatment Episode > Scheduling and Utilization tab.
- Click Edit next to the UR plan used to submit the claim.
- Make the necessary changes.
- Changes in the UR plan can be made to:
- Facility: If the service was rendered at a different facility.
- Service: The service on the claim can only be switched to another UR Required Service. For example, PHP was initially chosen but the patient attended IOP.
- Service Billing Profile: For example, the service needs to be sent as professional and there is already a billing profile created for this configuration. If the billing profile doesn't exist, click here for instructions.
- Rendering Provider: For example, the rendering provider initially chosen was incorrect and did not render those services.
- Billing Provider: For example, the service was billed under the rendering provider but needs to be billed by the practice.
- Authorized Status: For example, the wrong authorization status was selected.
- Authorization Number: For example, if the authorization number was entered incorrectly.
- Save the Utilization Plan.
- Navigate to the patient’s Insurance Billing tab and open the Review Corrections tab.
- Click Check for Corrections and click Submit.
- Once corrections populate, click Compare to view changes. Click here for more information on comparing claim versions.
- Click Resolve to create a corrected claim.
- Complete the Select Correction Action form as described in the Claim Corrections and Rejections article.
- Once the corrected claim is created, send it to the payer from the Submit Claims tab in the Work Center > Insurance Claims.
- If the desired corrections do not appear, refer to the Corrections Troubleshooting article.