Enter Additional Claim Information

When making a correction to a claim, you might need to add claim remarks. Refer to specific payer rules for correcting and adjusting claims.

1. In the Claim Remarks – CMS-1500 & UB04 section, click Add.
2. Enter the start and end dates of the claim.
3. Optional: In the Discipline field, type the discipline. If you leave it blank, then the value entered on the Case Information tab in the Discipline field prints on the claim.
4. Optional: In the Remarks field, type any additional information.

   

On UB-04 claims, you should document patient hospital stays that have occurred when the patient also received outpatient treatment during the same month. This helps prevent claim rejection.

1. In the Hospital Stays – UB04 section, click Add.
2. Enter the start and end dates of the claim.
3. In the Admission Code list, click the reason for the hospital stay.

   

Enter a patient occurrence here if you need to change the occurrence codes that INSIGHT automatically assigns. INSIGHT assigns appropriate PT-, OT-, or SP-related occurrence codes based on the values in the Discipline and Program Type fields on the Case Information tab.

1. In the Patient Occurrence – UB04 section, click Add.
2. Enter the start and end dates of the dates of service to which you want to attach the occurrence code.
3. In the Occurrence Code list, click or type the occurrence code that should print on the claim instead of the default code assigned by INSIGHT.

   

When submitting an adjustment claim, typically to Medicare, a condition code must be present in order to change the suffix of the TOB to a 7 or 8.

1. In the Patient Condition – UB04 section, click Add.
2. Enter the start and end dates of service to which you need to attach the condition code.
3. In the Condition Code list, click or type the occurrence code. Refer to specific payer requirements for more information.
4. Optional: In the Agency field, type the name of the agency responsible for the patient's condition code.

   

Enter information in this section if the payer requires additional value codes outside of what the system generates on an original claim.

1. In the Patient Value – UB04 section, click Add.
2. Enter the start and end dates of the service that you want the value code to apply to.
3. In the Value Code list, click or type the occurrence code. Refer to specific payer requirements for more information.
4. In the PVValue field, type the numeric value. This varies depending on which value code you entered.
5. Optional: In the Agency field, type the name of the agency responsible for the patient's value code.

   

Change CMS-1500 Settings

Change UB-04 Settings