Custom EDI Rules

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 […]

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Enter Charges

The charge entry process is the initial and one of the crucial stages in the billing cycle. To access the charge entry screen, Select Charges from the main menu and click on Enter Charges. This article explains the different fields in the charge entry screen. The Chart Entry Screen is divided into two main panes- […]

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X-Superbill

Description X-Superbill is used for charge entry and editing of bulk data. It facilitates billing of multiple patients simultaneously in a single screen and saves them to PracticeSuite. Bulk Patient Data coming in through the interfaces are processed using the X-Superbill screen. Features 1. Users Can Bulk-Hold lines in the X-Superbill X-Superbill screen has line […]

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UB04 Charge Entry

UB04 Charge Entry screen manages the entry and edit 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. Shown in Image 1 […]

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Procedure Groups

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 […]

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Case and Encounter

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 […]

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Encounter Lines

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 CPT Code The procedure codes used […]

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Edit Charges (Charge Master)

Overview of Charge Master The charge master/edit charges screen is the primary screen for editing charges. It displays the list of encounters grouped by case for the selected patient. For each encounter, the list of diagnosis codes, the procedure codes and their corresponding charges, the billed amount, the paid amount, the current status, etc. are […]

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Understanding the Billing Workflow

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 […]

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Common Clearinghouse Rejections – TriZetto

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 […]

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