Add Claim Form Procedure Description

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. 

Additionally, this rule is used to resolve the following rejection message: PROCEDURE DESCRIPTION IS REQUIRED FOR NON-SPECIFIC PROCEDURE CODE USED.

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 drop-down to Professional and change the order of the rule when applicable.
6. Then select Conditions to create criteria a claim should meet before the rule will apply.
7. Next, click on the Behaviors drop-down, select Claim Form Procedure Name, then click Add.
8. Update the drop-down 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.
      
9. To create multiple behaviors, repeat steps 7 and 8.
10. Click Save to complete the process.
    

Box Number(s)

• UB-04: N/A
• CMS-1500: Box 24- Service Lines

Frequently Asked Questions and Helpful Hints

Let's review some helpful hints and some more commonly asked questions!

Frequently Asked Questions

• The best way to determine if a scheduled change set is appropriate is to gauge how many claims will be affected. For example, if you want the rule to apply to previously billed claims as well as new claims going forward, create the rule without a scheduled change set. 
  
  However, if you want the rule to apply only to newly created claims, use a scheduled change set to instruct the system to look only for claims with dates of service on or after the set date. For more information on scheduled change sets, click here.
• If you are creating the rule to apply to previously billed claims, navigate to the Patient > Treatment Episode > Claims > Review Corrections section and click Check For Corrections. If corrections are generated, follow the process outlined here to complete the process. If no claims are flagged for rejection, click here to troubleshoot why the rule may not be applying.

Helpful Hints

If one of your conditions is payer-based, select any applicable Current Sequence options 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.