Claim Form Rule - Adding Claim Form Procedure Description

  • Updated

What claim change is needed?

When a claim is rejected for the reason "PROCEDURE DESCRIPTION IS REQUIRED FOR NON-SPECIFIC PROCEDURE CODE USED", a claim rule will be needed to require the Claim Form Procedure Name.

The Claim Form Procedure Name comes from the service billing profile Claim Form Service Name, but adds the name to the "Procedure Description" field in the clearinghouse instead of the "Service Line Note" field.

Box Number

CMS-1500: Section 24 - Service Lines

Steps

  1. Navigate to Management Center > Claim Rules
  2. Click "Create Claim Form Rule".
  3. Select the Practice.
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  4. Name the claim rule.
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  5. Set Claim Type to Professional.
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  6. Set conditions for the claim rule to be met.
  7. Select the Available Behavior: Claim Form Procedure Description.mceclip2.png
  8. Then click Add.
  9. From the Select dropdown arrow, choose Require and Write to Claim.mceclip3.png
  10. At the bottom of the window, click the Create button.

Related Articles

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.

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