These errors are generated when the nightly billing job runs and attempts to create charges from Services. Changes can be made to the Services/Plans and the nightly billing job will attempt to create charges the following night.
Charge errors that automatically cascade to the next plan or client:
- Clinician is not authorized to provide services to plan
- Clinician on service is not billable to this plan
- No charge for this code if a previous plan has denied the charge
- Non-billable primary diagnosis code
- Plan will not pay for this procedure
When all configurations are correct and charge error still exists
If charge is reviewed and no changes need to be done, can do one of the following:
- Write the charge off
- Override the charge error (by manually marking charge ‘Ready to Bill’)
- Bill the charge for the denial
Active Credential is Required for the Staff Associated to this Service
- Purpose: Triggers when licensure is expired/not valid
- How to resolve: Navigate to Staff Details > Licenses Degrees and update the Expiration Date of the license used for billing purposes
Attending Must Be Specified on a Service that Uses this Code
- Purpose: Prevents charge creation when Attending is not specified
- How to resolve:
- Navigate to Service and confirm ‘Attending Provider’ is filled in:
Authorization is Required
- Purpose: Triggers when Client does not have an Authorization
- How to resolve: Navigate to Authorizations (Client) and fill out Requested/Approved based on what Client is authorized for. With each Authorization, make sure to click ‘Insert’. Once done, click ‘Save’:
Client Address or its Components are Missing. Please Check Client Information
- Purpose: Triggers when Client address is in incorrect format/not filled in
- How to resolve:
- Staff navigates to Client Information
- Click ‘Details’ to review address information and update, then click ‘Save’:
Clinician on Service is Not Billable to this Plan
- Purpose: Triggers when Clinician does not have requisite licensure per Plan rules
- How to resolve:
- Staff ensures Clinician has correct license on Staff Details > License/Degrees
- Navigate to Plans (Administration) > Rules tab, select the Rule from Rule List. Make sure the correct Licenses are included on the Rule:
Clinician is Not Authorized to Provide Services to Plan
- Purpose: Triggers when Clinician on Service is not part of ‘Only these clinicians may provide billable services for these codes’ Plan Rule
- How to resolve: Staff ensures the correct Clinician was selected for the Service
- Navigate to Plans (Administration) > Rules tab, select the Rule from Rule List. Make sure the correct Plan is on the Rule:
Missing Billing Code. Please Check Procedure Rates/Billing Codes
- Purpose: Triggers when Billing Code is not associated to Procedure Code
- How to resolve:
- Navigate to Procedures/Rates and select affected Procedure Code
- Navigate to Rates/Billing Codes tab and review/add correct Billing Code
- Click ‘Modify’ then ‘Save’
Must Have These Dx’s for These Codes
- Purpose: Triggers when Client does not have specific diagnosis
- How to resolve:
- Staff updates Client diagnosis, then click ‘Refresh Diagnosis’ in the Service under the Services (Client) page
- Navigate to Plans (Administration) > Rules tab, select the Rule from Rule List. Make sure the correct diagnosis are listed:
- Write the charge off, bill the charge to the next Plan, bill the charge to the client
No Charge for This Code if a Previous Plan Has Denied the Charge
- Purpose: Triggers when Plan Rule ‘Only these clinicians may provide billable services for these codes’ is in effect and a Service’s rendering clinician is not on this list
- How to resolve:
- Staff ensures clinician is correct on the Service
- Navigate to Plans (Administration) > Rules tab and confirm the clinician list is accurate
No More Than X Contacts per Day/Week/Month/Yr
- Purpose: Triggers when Service exceeds allowed amount per period
- How to resolve:
- Staff reviews Service to confirm dates/times
- Navigate to Plans (Administration) > Rules tab, and select the Rule from Rule List. Click ‘Modify’ to review the number of contacts allowed.
No More Than X Contacts per Period (by Client)
- Purpose: Triggers when Service exceeds allowed contacts per period
- How to resolve:
- Staff reviews Service to confirm dates/times
- Navigate to Plans (Administration) > Rules tab, and select the Rule from Rule List. Click ‘Modify’ to review the number of contacts allowed.
No More Than X Duration Per Day/Week/Month/Yr
- Purpose: Triggers when Service exceeds allowed amount per period
- How to resolve:
- Staff reviews Service to confirm dates/times
- Navigate to Plans (Administration) > Rules tab, and select the Rule from Rule List. Click ‘Modify’ to review the number of contacts allowed.
No More Than X Duration per Period (by Client)
- Purpose: Triggers when Service exceeds allowed duration per period
- How to resolve:
- Staff reviews Service to confirm dates/times
- Navigate to Plans (Administration) > Rules tab, and select the Rule from Rule List. Click ‘Modify’ to review the number of contacts allowed.
Non-Billable Primary Diagnosis Code
- Purpose: Triggers when Plan has non-billable DX Rule set
- How to resolve:
- Staff ensures correct DX was selected for the Service
- Navigate to Plans (Administration) > Rules tab, select the Rule from Rule List. Make sure the correct DX is listed to be not billable:
Non-Billable Locations
- Purpose: Triggers when Service has non-billable Location selected
- How to resolve:
- Staff ensures correct Location was selected for the Service
- Navigate to Plans (Administration) > Rules tab, select the Rule from Rule List. Make sure the correct Location exclusions are on Rule:
Procedure Must Exist on a Treatment Plan Before Creating a Charge
- Purpose: Triggers when Procedure Code is not on Treatment Plan
- How to resolve:
- Staff ensures there is a signed Treatment Plan with
- specific Procedure Code
Navigate to Plans (Administration) > Rules tab, select the Rule from Rule List. Make sure the correct Procedure Code is on the Rule:
Program May Not Provide Services to This Plan
- Purpose: Triggers when Program is not associated to ‘Only these Programs may provide billable services or these codes’ Plan Rule
- How to resolve:
- Staff ensures correct Program was selected for the Service
- Navigate to Plans (Administration) > Rules and review Programs associated to Rule:
Subscriber Address or its Components are Missing. Please Check Client or Client Contacts
- Purpose: Triggers when subscriber to Client’s address is in incorrect format/not filled in
- How to resolve:
- Staff navigates to Client Information > Contacts
- Find the contact where ‘Financially Responsible’ is Yes, and click the radio button
- Update address/information, click ‘Modify’ then click ‘Save’:
These Codes will be Denied by This Plan
- Purpose: Triggers when Plan is not associated to Procedure Code
- How to resolve:
- Staff ensures correct Procedure was selected for the Service
- Navigate to Plans (Administration) > Rules tab, select the Rule from Rule List. Make sure the correct Procedure is listed to be not billable:
This Plan Will Accept Authorizations from the Plans Listed Below
- Purpose: Triggers when authorization is required for Procedure Code and specific Plans have been specified as approved
- How to resolve:
- Staff ensures the correct Procedure was selected for the Service
- Navigate to Plans (Administration) > Rules tab, select the Rule from Rule List. Make sure the correct Plan is on the Rule:
Unable to Calculate Allowed Amount/Expected Payment
- Purpose: Triggers when cannot determine charge amount/expected payment due to Procedure’s rates
- How to resolve: Navigate to Procedures/Rates and review Rate
Lock Out Scenarios
Purpose: There are two lock-out types in SmartCare:
- This code creates a lock out situation.
- This code creates a lock out situation. Please append the applicable billing code modifier.
If you receive the lock out error message: This code creates a lock out situation, this is a hard stop. This means that the service cannot be billed with the other service causing the lock out.
You can review the applicable Billing Service Table to see which code you billed for that day that it was not billable with for example, 90838.
These codes are NOT overridable with this code:
- You would need to either write off this service or change the procedure code to another similar code that is billable with your service of 90838.
NOTE: any changes made to a service should be discussed with the rendering clinician to discuss note changes, new note signing (if applicable), and what code they (the clinician) would like to use instead.
If you receive the lock out error message: This code creates a lock out situation. Please append applicable billing code modifier. This is a soft stop. You will just need to review the applicable Billing Service Table to see which modifier you can append to that service to clear the error.
For example; 90838.
These codes ARE overridable with this code:
You will notice that some codes have one asterisk (*) and some have two (**). This will tell you what modifiers are appendable to this code. you can find this on the very top of the Billing Service Table on column K.
How to Resolve: To add a modifier to a service, please follow these steps:
- Navigate to the Charges/Claims screen.
- Click on the Charge ID hyperlink that you are appending the modifier to.
- Once you click the Charge ID hyperlink, it will bring you to the charge details screen. Navigate to where it says “Billing Code”. there you will see a blue box that says “override”. Click the Override button.
- Enter your modifier into the first available box.
- Click Apply then Click save at the top right-hand corner of the screen.
- Click the X at the top right-hand of the screen to exit that screen to return to the charges/claims screen.
Missing Code or Modifier
- Purpose: If you receive the charge error “Missing Code. Please check plans and procedure codes”, it is because your claim is missing the billing code for that service. You will need to make sure that the procedure code is linked to the correct plan. The plan is where the system pulls the codes and modifiers from for the claim. To ensure this, please follow the instructions below to correct this error message.
- How to Resolve:
- Click on the Charge ID hyperlink.
- Once you click the Charge ID hyperlink, it will bring you to the charge details screen. Navigate to where it says “Billing Code”. click on the “rate ID” hyperlink. This takes you directly to the rate in question.
- A new screen with pop up. It is the Procedure code Details page. In both boxes, “Rate” and “Standard Billing Code”, the information of the rate being used is already populated
- Click on the blue button that says “modify”
- A pop-up box labeled “CoveragePlansPopUp” will show. Here is where you click the appropriate plans to link the procedure code to the plan.
- After you check the box(es) for the appropriate plans, click Save first then click Close on this pop-up box.
- Click the Save button in the top right-hand corner of the screen. Click X to close.
