Charge Entry: Additional Billing Info Tab

After you have searched for the Patient Record and entered Basic Charge details, you can add additional details on the Additional Billing Info tab.

• If editing a charge, view the Additional Information the Claim is currently set for, and adjust if desired.
• OR, if adding a charge, enter the appropriate Additional Information for the new charge.

Jump to Section:

Adjustment/Voided Section

Indicate if there has been an adjustment or if the claim was voided.

1. Select None if there is no change
2. Select Replacement if you are resubmitting the charge as a Replacement claim.
3. Select Void/Cancel if you are resubmitting the charge to the payer to void/cancel the charge.
4. Enter the Claim Reference Number that is being changed/voided.

Additional Options

Select any additional parameters.

1. Check Employment-Related if the claim is related to employment.
2. Check Auto Accident if the claim is due to an auto accident.
3. Check the SOF to indicate if the Signature is on File.
4. Check Emergency if the claim is due to emergency treatment.
5. Check Other Accident if the claim is due to an accident other than the options.
6. Check Accept Assignment to indicate that you agree to accept the payers allowable.

Attendance Billing

1. Enter any Dormitory Fees that are included in the claim.
2. Indicate the Unit measurement of the procedure on the claim.

Medicaid Billing

Select parameters for billing to Medicaid.

1. Select a Delay Reason Code if applicable.
2. Select an SA Exception Code if applicable.
3. Select any Special Programs if applicable.
4. Select Yes or No to indicate if the claim is an EPSDT/CHAP Referral.
5. Select Yes or No to indicate if the claim is related to Family Planning.
6. Select a Sterilization/Abortion code if applicable.
7. Enter a Prior Approval Number if known.
8. Enter any Related Causes if known.
9. Select Yes or No to indicate for Copay Exempt if the patient is exempt from the copay.
10. Select Yes or No for Spend Down and indicate the Amount of money you need to pay before Medicaid will start making payments if you selected Yes. 

Hospital Dates

1. Enter the Onset date of the patient’s symptoms if known.
2. Enter the patient's Admission date if known.
3. Enter the patient's Discharge date if known.

Next Steps - If applicable, add more Charge Information on the following tabs:

• Activity Items Tab
• UB-04 Tab
• Attachments Tab
• Claim List Tab