Entering Your Modifiers and Overrides


About Modifiers and Overrides

If the information entered in an appointment does not match the payor's requirements, you can set up override rules to update the information automatically. This eliminates the need to make manual changes.

Entering Your Modifiers

  • Go to BillingTracker > Settings > Modifiers > Modifier Codes

  • Click New.

  • Enter all required fields.

  • Save.

Entering Your Modifier Rules (Applied on Transition)

Modifier Rules associate Modifiers with combinations of Service, Insurer, Program, Place of Service, Clinician, and Credential. When transitioning the appointment, if a match is found, the selected modifiers will automatically be included. 

  • Go to BillingTracker > Settings > Modifiers > Modifier Rules.
  • In the Input section, select the appropriate fields: 
    • Service as entered in the ClinicTracker Service Input maintenance menu.
    • Insurer as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Program as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Place of Service as entered in the ClinicTracker Building/Billing Location maintenance menu. 
    • Clinician as entered in the ClinicTracker Staff Info form.
    • Credential as entered in the ClinicTracker Staff Info form.
  • Also included as an Input parameter, you can limit specific age ranges by years. The age can be calculated by Service Date or Current Date.
  • In the Output section, select 1-4 modifiers.
  • Select ALL from the dropdown to save bulk modifier rules.
  • If needed, set fee adjustments based on dollar amount or percentage. 
  • Save.

Entering Same Day Modifier Rules (Applied on Transition)

Same Day Modifiers Rules allow you to define a particular modifier for either multiple or same-day services, unique to each payor. To ensure they are not rejected/denied as duplicates, these modifiers indicate that the separate services were performed on the same day.

 

To set up Same Day Modifiers, go to BillingTracker > Settings > Modifiers > Same Day Modifier Rules.

  • In the Input section, type in a Rule Name. 
  • Select a Payor. 
  • Select a Service or Multiple Services. 
  • Click Yes or No if you require unique primary service codes. 
  • In the Output section, select the Modifier to use. 
  • Save.

Entering Your Claim Format Override Rules (Applied on Transition)

Claim Format Override Rules adjust the default claim format (CMS-1500, UB-04, 837, patient statement, insurer statement) for a given combination. When transitioning an appointment, if a match is found for the insurer/billing location/credential/clinician combination on the claim, this claim format will be assigned, as opposed to the default configured for the insurer.

  • Go to BillingTracker > Settings > Overrides > Claim Format Override Rules.
  • In the Input section, select the appropriate fields:
    • Place of Service as entered in the ClinicTracker Building/Billing Location maintenance menu. 
    • Insurer as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Credential as entered in the ClinicTracker Staff Info form.
    • Clinician as entered in the ClinicTracker Staff Info form.
  • In the Output section, select the Claim Format to use:
    • Paper Claim (CMS-1500)
    • Electronic Claim (ANSI-837)
    • Insurer Statement
    • Patient Statement
    • Paper Clam (UB-04)
    • Save.

Entering Your Billing Clinician Override Rules (Applied on Transition)

Sometimes you have to change the NPI code specific to a billing clinician. These rules are applied at the time of transitioning appointments.

  • Go to BillingTracker > Settings > Overrides > Billing Clinician Override.
  • Group the overrides according to when they are applied 
  • In the Input section, select the appropriate fields:
    • Service as entered in the ClinicTracker Service Input maintenance menu.
    • Insurer as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Program as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Place of Service as entered in the ClinicTracker Building/Billing Location maintenance menu. 
    • Clinician as entered in the ClinicTracker Staff Info form.
    • Credential as entered in the ClinicTracker Staff Info form.
  • In the Output section, select the Clinician to use. 
  • Save.

Entering Your Billing Location Override Rules (Applied on Transition)

This input form allows you to override the billing location for a claim based on a series of rules. These rules are applied at the time of transitioning appointments. To enter a rule:

  • Go to BillingTracker > Settings > Overrides > Billing Location Overrides
  • In the Input section, select the appropriate fields.
    • Service as entered in the ClinicTracker Service Input maintenance menu.
    • Insurer as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Program as entered in the ClinicTracker Program Input maintenance menu. 
    • Place of Service as entered in the ClinicTracker Building/Billing Location maintenance menu. 
    • Clinician as entered in the ClinicTracker Staff Info form.
    • Credential as entered in the ClinicTracker Staff Info form.
  • In the Output section, select the Location to Use.
  • Save.

Entering Your Insurer Override By Credential Rules  (Applied on Transition)

This input form allows you to override insurers by clinician credentials based on a series of rules. These rules are applied at the time of appointment transition. To enter a rule:

  • Go to BillingTracker > Settings > Overrides > Insurer Override By Credential
  • In the Input section, enter and select the appropriate fields.
    • Rule Name.
    • Primary Insurer as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Program as entered in the ClinicTracker Program Input maintenance menu. 
    • Credential as entered in the ClinicTracker Staff Info form.
  • In the Output section, select the Insurer to Use.
  • Save.

Entering Your Transmission Type Override Rules (Applied on Claim Processing)

Transmission Type Override Rules select the Electronic Claim Transmission Type based on combinations of Place of Service, Insurer, Credential, Program, and Service. If a match is found, this will be used instead of the Transmission Type configured on the insurer-plan level. This will avoid the need to create multiple insurance records if you send claims differently based on different criteria.  These rules are applied at the time of electronic claim processing.

  • Go to BillingTracker > Settings > Overrides > Transmission Type Override Rules.
  • Complete appropriate fields.
    • Place of Service as entered in the ClinicTracker Building/Billing Location maintenance menu. 
    • Insurer as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Credential as entered in the ClinicTracker Staff Info form.
    • Program as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Service as entered in the ClinicTracker Service Input maintenance menu.
  • In the Output section, select the required Transmission Type. If needed, click the settings button to review the Transmission Type Configuration.
  • Save.

Entering Your CPT Override Rules  (Applied on Claim Processing)

Sometimes you have to change the CPT code the system stores for a particular service due to the requirements of an insurance plan or program. This form allows you to configure a different value to submit for the CPT code.  These rules are applied at the time of electronic claim processing.

  • Go to BillingTracker > Settings > Overrides > CPT Override.
  • Complete appropriate fields
    • Service as entered in the ClinicTracker Service Input maintenance menu.
    • Insurer for which you are entering the CPT Code Override information.
    • Program for which you are entering the CPT Code Override information.
    • Patient Group for which you are entering the CPT Code Override information.
    • CPT Code that you will use instead of the default, when submitting claims to the selected payor.
    • Override Description is a description of the override rule.
  • Save.

Entering Your Location Type Override Rules  (Applied on Claim Processing)

This input form allows you to override the location type for a claim based on a series of rules. These rules are applied at the time of electronic claim processing. To enter a rule:

  • Go to BillingTracker > Settings > Overrides > Location Type Override Rules. 
  • In the Input section, select the appropriate fields.
    • Service as entered in the ClinicTracker Service Input maintenance menu.
    • Insurer as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Program as entered in the ClinicTracker Insurance Input maintenance menu. 
    • Place of Service as entered in the ClinicTracker Building/Billing Location maintenance menu. 
    • Clinician as entered in the ClinicTracker Staff Info form.
    • Credential as entered in the ClinicTracker Staff Info form.
  • In the Output section, select the Location to Use
  • Save.
More About Fees, Modifiers and Overrides

Fee Hierarchy

Entering Your Fee Schedules

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