Payer Rules: Add Modifier

Users can create billing rules that automatically assign modifiers for payers that require them based on place of service.

Required Permissions: You must be a Super Admin to add and edit payer and billing rules.

Creating a Billing Rule

Before you begin, you must create a payer rule. For detailed instructions, click here.

1. Once you've created a payer rule, click Add Billing Rule.
2. Select Add Modifier from the Billing Rule Type drop-down.
3. The rule will appear as follows.
4. Choose the trigger type.
1. Codes: Select Codes if you want to automatically tie modifiers to codes. Click on the Codes field and enter the necessary code.
2. Place of Service: Select Place of Service if you want to automatically tie modifiers to places of service. Click on the Place of Service field and choose the desired place of service from the drop-down.
3. Billing Provider: Select Billing Provider if you want to automatically tie billing providers to modifiers. Click on the Billing Provider field and choose the desired billing provider from the drop-down.
4. Duration: Select Duration if you want to automatically tie codes to durations. Enter the desired code, or codes, and enter the desired duration from and duration to minute values.
5. Modifiers: You can add up to four modifiers, and entering one modifier will make the next modifier field available.
6. Finally, click Update. The billing audit tool report will now automatically assign the chosen modifiers to the selected place of service or codes.