Service Location Not Approved By Payer

The Service Location Not Approved by Payer is a Payer-controlled Prebilling rule in the system to prevent billing visits if the location or address is not approved by the Payer. This measure is set to prevent fraud, waste, and abuse by ensuring that all services performed are done at an approved location. Therefore, Providers are expected to bill for services according to the address(es) identified in the Payer’s Member Profile.

The system compares the address(es) on file to the address being billed. When attempting to bill for a visit using an address that is not approved, the visit is held at Prebilling with a Location Not Approved listed in the Prebilling Problem(s) field in the Visit Info tab.

To resolve, the Provider can contact the Payer to add the address to their system. Once added on the Payer side, the system syncs and visit billing is reprocessed, clearing the hold. If the Provider has the permission to edit the Patient address, then the Provider can fix the address for the visit and reprocess.

On the Prebilling Review page under Billing > Prebilling, Location Not Approved appears under the Problem column.