Therabill users now have the ability to create electronic claim submissions containing more than six service lines and reporting codes in a single claim.
What This Means
In the past, Therabill generated electronic claim files (837 EDI files), which, like the paper CMS-1500 form, were limited to containing no more than 6 individual service lines per submission (i.e. no more than 6 combined CPT Codes and Reporting Codes on a single claim). If the claim submission for a single date of service contained more than a total of 6 service lines, Therabill was forced to split the Date of Service into two or more separate claim submissions. Often times, this led to the increased possibility of rejections or denials if certain service code combinations needed to be on the same claim form/file.
This new update will remove the 6 line restriction for electronic claim submissions and allows users to create electronic claims submissions which contain up to 50 individual service lines for a single date of service. This will reduce the risk of denials for splitting codes, especially for those payers like Medicare, which may require multiple FLR and PQRS service codes on a single date of service.
Who This Affects
This update will affect any user that submits claims for dates of service containing more than 6 service lines. This will particularly affect clinics who submit to Medicare and are enrolled in Claims Based PQRS and/or FLR reporting, as the Medicare Reporting codes (G-codes) are often what pushed the number of service codes on a session to more than 6 lines.
How Will This Affect Workflow?
There is no change to the way users will create their insurance claims. However, users submitting to Medicare, who previously had to manually re-order CPT codes in order to ensure the correct reporting codes ended up on the right claim, will no longer need to go through this re-ordering process. Electronic claims will now always be sent out with one date of service per claim. Print and mail claims will print as normal, based on the settings you choose at the time the claim is created.
However, since paper versions of claims are still limited to holding only 6 service lines, while electronic submissions can hold up to 50, the way submissions and claim forms are displayed in the Filing -> CMS-1500 area will look slightly different. (see image below)
There is a slightly updated process for creating Corrected Claims.