Correct CPT Code/Service Type for Submitted Claims (TheraNest)

  Permissions: You must have Billing Permissions.

IMPORTANT: Before you Begin

• Your claim needs to be in the Rejected Status for the Service type to be changed.
• If there are any Client and/or Insurance Payments on the Invoice, the Service Type cannot be changed. Remove Payment correct the Service Type/CPT Code and reapply the payment. 
• Check your EDI Files Settings to ensure Ask for resubmission details prior to Re-Submit failed claim is selected.

Correct the CPT Code

1. Click Billing tab in primary navigation bar.
2. Click Claims in side menu and click on Rejected/Denied tab.
   

   NOTE: If the Claim is not there, search for Claim and manually mark it as Rejected/Denied.

3. Click Actions for appropriate Claim and select View Invoice Details.
4. In Invoice Details, select the new Service Type from dropdown.
   

   NOTE: If the service type dropdown is grayed out, check for applied payments on the invoice and Remove Payment.

5. Click Save.
   
   
6. Then Resubmit Corrected Claim.
   • When resubmitting the Claim a dialogue box will pop up asking you to choose the resubmission code and enter the original reference number for the Claim. Resubmission details appear in Loop 2300 of the EDI file and Box 22 of form CMS1500.
     Resubmission Code =
     7 - replacement of prior Claim
     8 - void/cancel of prior Claim Original Reference Number(you may need to call the insurance payer to get the Original Reference Number).