Update Bill-Type Suffix

There are several rules available to adjust the Bill-Type Suffix on institutional claims. Let's review each suffix, its definition, and how to create a rule that will update the Bill-Type Suffix. 

Available Suffixes

This rule can assist you in creating the claim with one of the following suffixes:

• 0 = Indicates the dates within the claim are non-payable.
• 1 = Indicates the dates of service encompass the admit date through the discharge date.
• 2 = Indicates the first date of service for the claim is the admit date, and this is the initial interim claim to be submitted.
• 3 = Indicates the claim is interim. 
• 4 = Indicates the last date of service for the claim is the discharge date, and this is the last interim claim to be submitted.

Workflow

Let's review how to create a claim rule to manage the claim's bill-type suffix! 

1. Navigate to Management Center > Claim Rules.
   
    
2. Click Create Claim Form  Rule.
   
3. Select the Practice.
   
4. Next, give the rule a name. As a best practice, we recommend including the payer name and the rule's desired behavior to make it easier to identify.
5. Leave the Claim Type field as Institutional and change the order of the rule when applicable.
6. Next, select the desired Conditions to create criteria a claim should meet before the rule will apply.
   
7. Next, click on the Behaviors drop-down, select Bill-Type Suffix, then click Add.
8. Update the dropdown to one of the following:
   • 0 to indicate the dates within the claim are non-payable.
   • 1 to indicate the dates of service encompass the admit date through the discharge date.
   • 2 to indicate the first date of service for the claim is the admit date, and this is the initial interim claim to be submitted.
   • 3 to indicate the claim is interim. 
   • 4 to indicate the last date of service for the claim is the discharge date, and this is the last interim claim to be submitted.
   • 2/3/4 to instruct the system to determine which bill-type suffix to use based on the dates of service included within the claim.
9. To create multiple behaviors, repeat steps 7 and 8.
10. Finally, click Save to complete the process.
     

Box Number(s)

• UB-04: Box 4 - Type of Bill
• CMS-1500: N/A

Generating Corrections

After a claim rule is created, the system should generate corrections for any claims that meet the conditions established within the claim rule. For more information on creating corrections, click here. 

Claim rules that only modify the bill-type suffix will require additional steps to ensure the correct bill-type suffix is added before resubmission can occur. Follow the steps below to update the bill-type suffix on the claim.

1. Navigate to the Patients section of the RCM and locate the desired patient.
2. Next, click the Claims quick link.
3. Locate the claim and click Resubmit.
4. Use the process outlined here, starting at step 4.
5. Once you have created the resubmission/correction, navigate to Work Center > Insurance Billing > Submit Claims. Locate the recreated claim and click View.
6. Confirm the correct suffix is displayed in the claim and follow the process outlined here to complete the process.
   
    

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.