When changes to the service are needed on a case-by-case basis and there are no specified conditions that should prompt the change, you can create a separate service. Because standalone services do not have the option to manually select a billing profile during the claim creation process, creating a new service that fits the payer's requirements allows users to choose between options in the attendance calendar. To make as-needed changes, create a new standalone service.
Example: Itemization is sometimes needed for a service but there are no specified conditions that would prompt this.
Do Not Use: If there are conditions that should prompt the changes. Example: Itemization is needed for Cigna claims. In this example, a claim rule to set a billing profile would be more appropriate.
Additionally, do not use the following process for UR Required services.
Create a New Standalone Service
Let's review the process for creating a new standalone service and using that service to generate and submit a corrected claim.
- Navigate to Practice Admin > Services.
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. - Click Create Service.
- Complete service configuration. For help with this, please see How to Create a Service and Set Rates. Ensure you choose No for Attendance Calendar - Requires Utilization Plan or Service Rate.
- To switch the previously billed service for the new configuration navigate to the Attendance calendar. Select the week in question from the Week drop-down.
- Click the lock next to the previously submitted service.
- A warning will populate to verify if the service needs to be unsubmitted and will list the associated claim number. Ensure that this claim number matches the claim that needs corrections.
- Click Unsubmit.
- Click the Edit icon to modify the service.
- Under the Service drop-down select the newly configured service and Save to update the service.
- Repeat this process for each date of service on the claim that requires edits.
- Click Submit Treatments. If the claim spans multiple weeks, navigate to the Unsubmitted Attendance tab and Submit Treatments for Billing from there.
- Next, click on the patient's name.
- Navigate to the patient’s Treatment Episode and open the Insurance Billing > Review Corrections tab.
- Click Check for Corrections and click Submit. 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.
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