Category: Charges & Claims

Insurance Discovery Program Practice Management System has enhanced its revenue cycle management (RCM) capabilities by launching an insurance coverage discovery feature in partnership with Experian Health (Wave). This automated tool retrieves patients’ insurance information—such as billable Medicaid, Medicare, and commercial plans—from Experian. It helps identify coverage that may have been previously unknown, forgotten, or not […]

PML for UB04 Claims Practice Management System has introduced a new case-level feature to record the patient’s monthly liability (PML), i.e., their out-of-pocket expenses for institutional claims, particularly for Medicaid plans. A new tab labeled Manage Pat. Resp is now available on the Case screen and includes three new fields to capture the liability amount, […]

Custom EDI & Eligibility Rules Currently running Custom Claim Rules in Practice Management System 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 […]

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

The UB04 Charge Entry The UB04 Charge Entry screen manages the entry and editing of UB04 charges (institutional 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 diagnoses. 3. Revenue codes are mandatory, whereas procedure […]

Procedure Group 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 procedures in the group, along with their amounts, get populated in the respective fields during charge entry. Thus, the creation of a procedure group aids […]

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 […]

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. Insurance Charge Workflow 1. All charges saved and not yet billed fall under NEW status. Save the charge with status Bill to PR to post the charge. 2. After the first batch generation & submission of the claim, the line status is changed by the system to Claim Sent to PR. This indicates the […]

Image 1 provides a visual example of the appointment view as seen in the Charge Entry screen. Image 1 Color categorization helps easily identify the charge status and 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 the […]