Update Resubmission Code

This rule adjusts the resubmission code on a professional claim. 

Workflow

Let's review how to create a claim rule to adjust the resubmission code on a professional claim!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Claim Claim Form Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
  5. Update the Claim Type to Professional.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, click on the Behaviors dropdown.
  8. Select Resubmission Code.
     
  9. Next, click Add.
     
  10. Input the desired Resubmission Code.
      
  11. To create multiple behaviors, repeat steps 7-10.
  12. Click Save to complete the process.
       

Box Number(s)

• UB-04: N/A
• CMS-1500: Box 22 - Resubmission Code/Original Ref. Number

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.