Entering Your Modifiers and Overrides

 

About Modifiers and Overrides

If the information entered in an appointment does not match the payors 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 Settings > Modifiers > Modifier Codes

  • Click New.

  • Enter all required fields.

  • Save.

Entering Your Modifier Rules

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

  • Go to Settings > Modifiers > Modifier Rules.
  • Select the Service, Insurer, Program, Place of Service, Clinician, and Credential, as well as 1-4 modifiers.
  • Select ALL from the dropdown to save bulk modifier rules.
  • Save.

Entering Your Claim Format Override Rules

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 Settings > Claim Format Override Rules.
  • Go to BillingTracker > Setup > Billing Clinician Override.
  • Complete appropriate fields.
  • Save.

Entering Your Transmission Type Override Rules

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. 

  • Go to Settings > Transmission Type Override Rules.
  • Go to BillingTracker > Setup > Billing Clinician Override.
  • Complete appropriate fields.
  • Save.

Entering Your CPT Override Rules

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.

  • Go to 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 Billing Clinician Override Rules

Sometimes you have to change the NPI code

  • Go to BillingTracker > Settings > Overrides > Billing Clinician Override.
  • Complete appropriate fields.
  • Save.

Entering Your Location Type Override Rules

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. 
  • Complete the appropriate fields.
  • Save.

Entering Your Billing Location Override Rules

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 > File > Setup > Overrides > Billing Location
  • Complete the appropriate fields.
  • Save.
More About Fees, Modifiers and Overrides

Fee Hierarchy

Entering Your Fee Schedules

Was this information helpful?

The page cannot be found

The page you are looking for might have been removed, had its name changed, or is temporarily unavailable. Please make sure you spelled the page name correctly or use the search box.