Payer Rules: Service Review

The Payer Rules tab allows users to create billing rules specific to each insurance. This rule allows users to select codes that will automatically produce an error flag when included on an outpatient or ancillary billing item without a completed service review. Before you can add a Service Review rule, you must first create the payer rule. Click here for instructions on creating the payer rule.

Building a Service Review Rule

Once you have your payer rule parameters created, the next step is to create the Service Review billing rule.

1. Click Add Billing Rule.
2. Choose Service Review from the Billing Rule Type drop-down.
3. Next, add the code (or codes). You can select one or multiple codes as needed.
4. The Require Authorization field is set to Yes and cannot be changed.
5. Click Update to save your changes.

Now, when this payer rule is created and matches a billing item with the outpatient/ancillary billing type where the service authorization is missing, it will add the red error.