This topic discusses things that can happen to a charge that is out of the ordinary and can delay your clinic's ability to post the charge and create a claim.
|Issue||What You Need to Do to Fix|
|CPT code used does not have a price set.||Open the Fee Schedule Editor to add the CPT code to the fee schedule.|
|Incorrect modifier used, or modifier missing.||
Open the Enter Charges window to manually change or add a modifier (such as 59, for a separate distinct procedure).
To add modifiers to Posted Charges for multiple dates of service at once, use the Apply Batch Modifiers tool.
|Wrong fee schedule used.||Open the Edit Payer window to check your payer settings. For example, a payer can categorized as workers comp on the Demographics tab of the Edit Payer window but is set as a commercial payer in the fee schedule.|
|Therapist has changed documentation Payer does not allow a specific CPT code to be used and the fee schedule doesn't say this CPT code isn't allowed.||
Manually add the charge necessary and delete the original charge.
|Claim being sent to payer includes multiple CPT codes, (some valid and some that need to be fixed).||
Void the claim and manually add the charge that needs to be fixed and resubmit the claim.