Change Claim Delivery Method

This rule allows for the delivery method of a claim to be updated without needing to reconfigure the payer's profile. 

Workflow

Let's review how to create a claim rule that can update the delivery method of a claim!

• 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 Set Values, click Set Claim Method To.
  8. Update the toggle to Yes.
     
  9. Click Save to complete the process.
      

Box Number(s)

• UB-04: N/A
• CMS-1500: N/A

Helpful Hints

• If you are creating a rule that changes the delivery method to paper,  you must add the paper payer's address in the payer's profile under the Practice Admin > Payers > Payer to ensure rule applies.
• 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.