PracticeSuite in association with CMS Pricer has the real-time CCI edits claims scrubbing feature implemented.
Screens where CCI Validation is Currently Available
A. Charge Entry
B. Charge Master (Edit Charges)
C. Claims Workbench.
How To Setup CCI Validation with CMS Pricer
Setup is done from the Practice Options page(see highlighted portion in Image 1). PracticeSuite internal team will enable the CCI edit option for the accounts.
CCI Validation from Charge Master and Charge Entry
The Workflow to run the Claims Validation rule from both Charge Entry and Charge Master screens will remain the same. The only difference is that if Claims validation with CMS Pricer is enabled for the practice, CE and CM screens will show the errors from CMS Pricer.
CCI Error Bucket in Claim Workbench
PracticeSuite has a new bucket built in Claims Workbench to include all the encounters which has validation errors at the time of claim Generation.
This Bucket is only available to the accounts which have CMS Pricer Enabled.
While generating the claims from Ready to Submit Bucket, when the user checks ‘Run Claim Validation’ check box, a Claim Rule validation popup appears with Errors, Warnings and Messages of the encounters submitted; see Image 2.
If the user clicks the ‘Proceed The claim generation’ without making any changes (i.e., Move Charges with error to CCI-Error is checked), all the Encounters with Errors will be moved to CCI error bucket and all other encounters will be generated as Claims.
For all encounters moved to CCI error bucket, System will update the line status as ‘HOLD’ and line sub status as ‘CCI Error’.
If the user clicks the ‘Proceed The claim generation’ button after unchecking the check box ‘Move charges with error to CCI-Error’, then all the encounters will be generated as claims without moving to CCI Error Bucket.
CCI Validation In XSuperbill
Users can select the claims and hit “Run claim validation” option and any claims that have errors are moved to the CCI_ERROR list. Note that to quickly locate the errored claims, the errored count is displayed in red. Please see Image 3.
A. On the validation popup screen, click on the “Move Error Charges to CCI-Error Bucket” to move all charges with error to the CCI_ERROR list in Claims Workbench (Submit Claims); see Image 4.
B. Click on the CCI_ERROR bucket to list the validated claims with errors. The besides the Provider Name in the charge listing will show the errors on mouseover (refer to Image 5).