Knowledgebase
How do I split a claim to rebill one service line?
Posted by Cari Callan on 28 June 2013 04:37 PM

This article will explain how to split a claim when there are multiple service lines on a claim and insurance does not pay on all of the service lines and the unpaid service line(s) to be rebilled.

Example Claim

 Split Claim S1

 

  1. In Remittance Posting, pull up the claim.
  2. Click on the service line that has been denied or not processed.
  3. Right Click
  4. Select Marked Denied - Resubmit

 Split Claim S2

  1. This will mark the service line with a ‘R’ and gray out the paid and write-off column.  You will be able to add the EOB reason code for the denial.  The remaining balance does not go to the patient and there is no insurance payment posted to the line item(s) that have marked as denied to resubmit.
  2. Continue posting the rest of the insurance payment normally.

 Split Claim S3

  1. Once you have applied to payment, go to Claims Management
  2. Go to Underpaid/Denied
  3. Find the claim that you marked denied.  Note that paid service line(s) are marked as paid and the denied line(s) is marked as ‘Denied’.

 Split Claim S4

  1. In this example, the service line 99213 was denied as being included in other paid services because I did not bill with a  -25 modifier.
  2. Highlight the claim and right click
  3. Select Go To
  4. Select Patient Ledger

 Split Claim S5

  1. Find the service line to be corrected, highlight the service line and right click.
  2. Select Edit Transaction
  3. In this example, I am adding the -25 modifier.
  4. Click Save

 Split Claim S6

  1.  Go Back to Claims Management
  2. Highlight the claim and right click
  3. Select ‘Requeue Unpaid Service Lines’ then ‘Edit & Send to Queue’

 Split Claim S7

  1. Make any necessary notes related to the rebilling of the claim.
  2. When the Modify Claim box appears, select the yellow square to update the claim from the changes made in the database.

 Split Claim S8

  1. Click Save
  2. PracticeStudio will split the unpaid service line(s) to a claim and the paid line item(s) to another claim (still marked as paid). 
  3. The unpaid service line(s) claim will be in Queued Claims ready to be submitted with the modifications made.
Split Claim S9
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