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. 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 Institutional.
        
     6. Select Conditions to create criteria a claim should meet before the rule will apply.
        
     7. Next, click on the Behaviors dropdown.
     8. Select Bill-Type Suffix.
        
     9. Next, click Add.
        
     10. 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.
     11. To create multiple behaviors, repeat steps 7-10.
     12. 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 implemented, the system should generate corrections for any claims that meet the conditions established within the claim rule. However, corrections that only modify the bill-type suffix will require additional steps to ensure the correct bill-type suffix is added.

• • 
    
    1. 1. Navigate to the Work Center > Insurance Claims > Create Corrected Claims section.
           
       2. Locate the correction you wish to generate.
           
       3. Select Compare to see the changes the system will make to the claim when the correction is generated.
          
          
          1. Please note - if you only intend to change the bill-type suffix, the Patient Control Number and the Type of Bill will be the only differences highlighted. 
             
       4. Once you confirm the proposed corrections are accurate, click the Resolve button.
          
       5. In the Corrections screen, toggle on Submit as New Claim; this step instructs the system to update the bill-type suffix using the rule.
          
       6. Select the Resubmission Issue and select Resolve.
           
       7. Submit the claim using the process outlined here. 

Helpful Hints

• 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.