Set Service Billing Profile

This rule can update the service billing profile used in the creation of a claim.

Workflow

Let's review how to create a claim rule to update the service billing profile!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Service Grouping Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
     
  5. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  6. Under Service, update the dropdown with the service you want the rule to apply to.
     
  7. Next, under Behaviors, click Set Service Billing Profile.
  8. Update the dropdown to the desired billing profile.
     
  9. Click Save to complete the process.
      

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.