UR Required Services: Changes to the Existing Billing Profile

Changes are needed for a group of claims submitted under the same billing profile. Make changes to the existing Billing Profile if the changes should impact all claims submitted using the profile in question.

Example: A billing profile is only used to submit claims to BCBS and the changes are needed for BCBS claims.

Do Not Use: If the changes are only appropriate for a subset of claims submitted using the billing profile. Example: The default profile is used for all payers, but changes are only needed for UMR and UHC.

Modify an Existing Billing Profile

1. Navigate to the patient’s Treatment Episode and open the Scheduling and Utilization tab.
2. From the UR tab, locate the UR plan used to submit the claim.
3. Tip: If it is not clear which UR plan will correct the claims, click edit to the right of the potential UR plan.
4. All associated claims are listed under the warning at the top.
5. Note the Service and Service Billing Profile selected on the UR plan.
6. Navigate to Practice Admin.
   Note: Only Admin users can access this tab. Contact one of your account admins to make the needed edits if this tab is not visible.
7. Click on the Services tab and locate the service from the UR plan.
8. Click on the Service and open the Billing Profiles tab.
9. Click to open the billing profile used to submit the claim.
10. Evaluate the scope of the change 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.
    • Claims back to a certain date: To make a change that will impact only existing claims from a certain date of service, make a Scheduled Change Set for that effective date.
    • Dates going forward: If the changes are only needed for dates of service going forward, make a Scheduled Change Set for that effective date.
11. Navigate to the patient’s Treatment Episode and open the Insurance Billing > Review Corrections tab.
12. Click Check for Corrections and click Submit. Wait for corrections to populate.
13. Once corrections populate, click Compare to view changes. Click here for more information on comparing claim versions.
14. Click Resolve to create a corrected claim.
15. Complete the form as described in the Claim Corrections and Rejections article.
16. Once the corrected claim is created, send it to the payer from the Submit Claims tab in the Work Center > Insurance Claims.
17. If the desired corrections do not appear, refer to the Corrections Troubleshooting article.