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Billing Errors: Charge Creation Errors and Resolutions

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:

  1. Write the charge off
  2. Override the charge error (by manually marking charge ‘Ready to Bill’)
  3. 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:
    1. 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