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Error Type: 4403 Unable to Find a Matching Rate for the Procedure or Missing Billing Procedure Rate

This error can occur for several reasons:

First reason: The clinician does not have a license/degree listed on the license/degree tab in staff/user.

  • Example: Procedures are reimbursed predicated on your license/degree. SmartCare needs a license/degree to calculate the procedure code by.
    • Fix: Contact your System Administer to make sure the clinicians, license/degree is listed on the staff details screens.
  • Note: The clinician may have a license but does not have a license that can bill that particular procedure code. This is especially true in group services, where the procedure code is not limited by facilitator license/degree. You may need to change the procedure code associated with these group services to a code that this clinician can bill, so long as it’s appropriate to do so. 

Second reason: The procedure code doesn’t have a Service Area Plan (Mental Health) or (Substance Use) associated with it.

  • Example: Mental Health and Substance Abuse has mutual procedure codes that are both MH and DMC, however, the rates are different. Therefore, SmartCare needs the Service Area Plan defined for each procedure code to calculate.
    • Fix: Contact your System Administrator to modify the procedure code to add the Service Area Plan.

Third reason: The level of care modifier doesn’t exist for the procedure code.

  • Example: If a service has a location of Telehealth Audio selected and the service did not have that modifier for Telehealth Audio. Or, if a program that should have a level of care modifier, but it didn’t pull a modifier because that program was not selected.
    • Fix: Contact System Administer to check the Procedure codes against the programs.

Fourth reason: The procedure code requires a minimum number of minutes before a charge can be calculated.

  • Example: If the procedure code range is set up in the system to start from 30 minutes to 1440 minutes, but the clinician marked the service duration for 5 minutes.

Fifth reason: The procedure code has maximum minutes that can be billed.

  • Example: If the procedure code minutes maximum is 90 minutes and the service is 100 minutes. It will not calculate the rate.

Updated 9/26/23