Billing Review Problems and Resolutions

Billing Review  checks visit information against export requirements specific to each Payer. If a visit violates a rule stipulated by a Payer, it is held at Billing Review until the error is corrected. Therefore, users are not able to print invoices or submit e-claims.

Billing Review

10 min.

Problem	Resolution
Alt Patient Number should not be blank Alt Patient ID must be 11 characters Missing Contract Start Date	Search and select the applicable Patient Profile under Patient > Patient Search. In the Patient Profile, click the Contract page link from the left navigation index. Click the Edit link in either the Alt Patient ID or Service Start Date column. Enter a value for the Alt Patient ID and or the contract Start Date.
Does NOT meet POC Compliance Requirements	Review the Contract Required Compliance rules. Click the Edit icon to open the Visit window and select the Visit Info tab. Manually enter the Duties to satisfy the Required Compliance rule. Click Save.
Dx Code May Fail Specificity Guidelines (if configured to validate for Flag 10 ICD Codes)	Go to Patient > Authorizations/Orders. Click the Edit link to open the Patient Authorization window. Click the Add button in the Billing Diagnosis Code(s) section. On the Authorization Default DX Code, click the ? to the right of the ICD field to search for the diagnosis. Click the most specific ICD code that applies to the Patient without a Flag code. Click Save to apply the ICD Code to the authorization.
Invalid CNR Import Reference Number	Search and select the applicable Patient Profile under Patient > Patient Search. In the Patient Profile, click the Calendar page link from the left navigation index. On the Calendar Date cell, click the V link to access the visit. In the Schedule tab enter the correct CRN Import Reference Number. Click Save.
Missing Authorization Number	Search and select the applicable Patient Profile under Patient > Patient Search. In the Patient Profile, click the Authorization/Orders page link from the left navigation index. Click the Add button to enter a new authorization or click the Edit link to update an existing one.
Missing Caregiver NPI Number Missing Caregiver Professional License Number (PLN)	Search and select the applicable Caregiver Profile under Caregiver > Caregiver Search. In the Caregiver Profile, click the Profile page link from the left navigation index. Enter the Caregiver NPI Number and/or the Caregiver PLN Number. Click Save.
Missing CNR Employee Number	Search and select the applicable Caregiver Profile under Caregiver > Caregiver Search. In the Caregiver Profile, click the Others page link from the left navigation index. Enter the Caregiver CNR Emploee Number. Click Save.
Missing Export Code Missing Revenue Code Missing Taxonomy Code	Go to Admin > Reference Table Management. Select Contract Service Code from the Reference Table field. Locate and select the applicable Service Code. Enter the respective value in the Export, Revenue, and/or Taxonomy Code fields. Click Save.
Missing Patient Name Missing Patient Address Missing Patient City Missing Patient State Missing Patient Zip Code Missing Patient Date of Birth Missing Patient Gender Missing Patient SNN Medicaid Number must be 8 characters Miss Patient MR Number (appears as Patient ID)	Search and select the applicable Patient Profile under Patient > Patient Search. In the Patient Profile, click the Profile page link from the left navigation index. Click the Edit button. Enter values for the missing Patient information in the corresponding field(s). Click Save.
Missing Physician NPI Number	Seach and select the applicalbe Physician under Admin > Physician > Physician Setup. Enter the Physician's NPI Number. Click Save.
Missing Primary Diagnosis	Search and select the applicable Patient Profile under Patient > Patient Search. In the Patient Profile, click the MD Orders page link from the left navigation index. Click the Add button to enter a new MD Order or click the MD Order ID link to edit an existing one. In Section 11 Primary DX click the Add button to enter the Patient's Diagnosis.
Pending Billing of Additional Shifts on Same Day	Go to Action > Confirm Visits. Use the search filters to locate additional visits on the date in question. Confirm any applicable visits and click Save for each one.
Review Contract Start Date and Alt Patient Number Missing Contract Start Date Discharge Date Elapsed	Go to Patient > Contract. Review the Alt Patient ID. Click the Edit link and enter the Alt Patient ID in the text window. Contact the Payer if the field is unavailable to edit. Click the Update link. Review the Service Start Date. Click the Date link to edit on the pop-out window. Click Save.
Visit should NOT be placed on Manual Hold	Go to Billing > Invoice Search > By Visit. Use the search filters to locate the Invoice in question. Click the Y link in the E-Billing Manual Hold column. Select Single Claim from the options. Click OK.
Visit Start/End Time cannot be blank Missing Service Code Visit cannot have TEMP Authorization Missing Caregiver Name Scheduled hours exceed Authorization Schedule Duration does not match Authorized Hours Billing by Export Code Greater than 24 Hours Maximum hours should not exceed the limit specified	Go to Visit > Visit Search. Use the search filters to locate the visit with missing and/or incorrect information. Click the Edit icon to open the Visit window. Go to the appropriate tab to fix and/or enter the required information. Click Save.
Visits on Same Day/Service Code must be Billed on same Invoice	Option 1 Merge Invoice Go to Billing > Invoice Search > By Visit. Use the search filters to locate the visit(s) in question. Review the visit(s) to verify that they were billed on the same day and have the same Service Code. Once confirmed, select the applicable vist(s) checkbox(es) and click the Merge Invoices button. Option 2 Delete Invoice Go to Billing > Invoice Search > By Invoice. Use the search filters to locate the Invoice in question. In the Invoice, review visits to verify they were billed on the same day and have the same Service Code. To remove visits from the Invoice, click the Delete icon. Click the Patient Name link to route to the Patient Calendar. On the Calendar, select the visit to access the Visit window. On the Visit window edit the Service Code. Click Save. Additional steps may be required if visits are exported or paid.