Use this process to make changes to an existing Billing Profile if the changes should impact 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: Don't use the following process if the changes needed are only appropriate for some 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
- Navigate to the patient’s Treatment Episode > Scheduling and Utilization tab and click on Attendance History.
- Locate the Date and Service that corrections are needed for. Note the Service Billing Profile used to submit the claim.
- 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.
- Open the Services tab and locate the service from the UR plan.
- Click on the Service and open the Billing Profiles tab.
- Click to open the billing profile used to submit the claim.
- 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.
- Navigate to the patient’s Treatment Episode and open the Insurance Billing > Review Corrections tab.
- Click Check for Corrections and wait for corrections to populate.
- 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 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.