Add Claim Form Procedure Description

This rule can add the Claim Form Procedure Description to a professional claim. The Claim Form Procedure Name comes from Claim Form Service Name located within the billing profile. This information is then used to add the name to the Procedure Description field when the claim is submitted to the clearinghouse instead of the Service Line Note field when a rule is in place. 

Workflow

Let's review how to create a claim rule to add the Claim Form Procedure Description to a professional claim!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create 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 Claim Form Procedure Description.
     
  9. Next, click Add.
     
  10. Update the dropdown to one of the following choices:
      1. Omit to create the claim without the Claim Form Procedure Description when present.
      2. Require and Write to Claim to always include the Claim Form Procedure Description. 
         
  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 24- Service Lines

Helpful Hints

• This rule can be used to resolve the following rejection message "PROCEDURE DESCRIPTION IS REQUIRED FOR NON-SPECIFIC PROCEDURE CODE USED."
• 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.