Category: Charges & Claims

Currently running Custom Claim Rules in PracticeSuite are discussed below. Rules are clearinghouse specific. They can be viewed at EDI configuration page under Advanced Setup->Billing Options->Batch Grouping Rule->EMC Receiver ->Configure.   Custom Rules for Professional Claims # Title Description Rule 1. To make Billing Provider Solo [2010AA-NM1][Box33] <PAYERID>:SOLO:PROVIDERNPI    (NPI populated from provider Master) <PAYERID>:SOLO:<NPI> <PAYERID>:SOLO:<NPI>:<LAST NAME>:<FIRST […]

Charge Entry The charge entry process is the initial and crucial stage of the billing cycle. This article explains the different fields in the charge entry screen. The Charge Entry Screen has two main panes: the Appointments pane and the Charge Entry pane (Image 1). Image 1 I. Appointment Pane The pane helps to easily […]

The UB04 Charge Entry UB04 Charge Entry screen manages the entry and editing of UB04 charges. Some key points related to UB04 Charge Entry are: 1. UB04 charge entry is used for institutional claims only. 2. There is no mapping between procedure codes and diagnosis. 3. Revenue codes are mandatory, whereas procedure codes are not. […]

A procedure group is a collection of procedure codes that are often used in conjunction. When the group code is entered in the procedure code field, all the procedure codes in the group, along with their amounts, get populated in the respective fields during charge entry. Thus, the creation of a procedure group aids in […]

Case and encounter are co-related and relates the patient insurance (Patient himself)to each bill item ( Encounter). Hence you can find the case and encounter listed in Edit charges. From the Main Menu, select Charges and click on Edit charges to open the Edit charges page. When the Edit charge page opens up, click on […]

Encounter Lines displays the different Procedures associated with an Encounter, DOS start and End Dates, the related diagnoses, the Charges, and Total Amount, Adjustment Amount, Claim Status, Accounting date, etc. Refer to Image 1. Image 1 Table 1 describes each field of the Encounter Line in detail. Field Description Proc. Code The procedure codes used […]

Overview of Charge Master The charge master/edit charges screen is the primary screen for editing a patient’s charges. The left pane displays all encounters of the selected patient grouped by case. Clicking on any encounter will list the diagnosis codes, the procedure codes and their corresponding charges, the billed amount, the paid amount, the current […]

A. Insurance Charge Workflow 1. All charges saved and not yet billed fall under NEW status. Additionally, any charge crossed over from EHR to the billing would also appear in the “NEW” status on the Enter Charges screen. Save the charge with status Bill to PR to post the charge. 2. After the first batch […]

Common Clearinghouse Rejections (TPS): What do they mean? Rejection Message Payer Rejection Type Information MB – Subscriber and Other Subscriber Claim Filing Indicator Codes cannot both be MB. 2320.SBR*09 Not Payer Specific TPS Rejection What this means: The primary and secondary insurance on this claim are both listed as Medicare plans.  This is not valid. Provider […]

A sample screenshot of the appointment view in the Charge entry screen is shown in Image 1. Image 1 Color categorization helps to easily identify the charge status and to locate an unposted charge. Table 1 gives a brief description of each color code. Color Description Indicates that no charge has yet been created against […]