Charges on the Billing Report undergo several validations to ensure that the billable items meet certain requirements. The goal of these alerts is to help prevent claim rejection and/or denials that can occur when billing an incomplete charge.
There are two types of alerts:
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Red: Error state. You cannot bill the charge until the error is resolved. These errors must be resolved before the claim can be transmitted, grouped, or marked as Do Not Bill. When an error is resolved it can take 5 to 15 minutes for the error to be removed from the Billing report by the system.
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Yellow: Warning state. You can bill without resolving the warning. These warnings do not need to be resolved before the claim can be transmitted, grouped, or marked as Do Not Bill.
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Both: You can also encounter both Red and Yellow together. In this instance, you must resolve the Red before billing and determine if the yellow needs to be resolved.
- Important: Some of the alerts allow modifications to the type. For example, if you would prefer to prevent charges from being billed when the date of service is before the admission date, you can change that alert from a warning (yellow) to an error state (red). Click here for instructions.
Post-Transmission Errors
The errors and warnings described in this article appear on the Billing Report before the charges are transmitted. For a list of errors that can occur after the attempted transmission from the Billing Report, check out the related article by billing integration: CollaborateMD | AveaOffice.
Error/Warning and Resolution
When an item is fixed it can take 5 to 15 minutes for the error to be removed from the Billing report by the system.
Error Message |
Solution |
Type |
Authorization is outside the effective dates of the insurance. |
This error occurs when the patient’s authorization date range does not occur within the insurance’s effective dates. To correct the issue, navigate to the patient’s chart and ensure the information for the concurrent review and insurance are entered correctly. |
Error, not customizable. |
Authorization's insurance does not match billable item's insurance
|
This generally occurs when there is an overlapping authorization or the insurance on the Facesheet does not match the Payer List.
To resolve this issue, please follow these steps to resync the auth with the insurance:
|
Kipu EMR
|
Billing Provider is missing. |
This warning appears when the billing provider is missing from the charge due to an incorrect Konnector set-up. To fix this issue, review the Konnectors set-up. Note: This error is known to occur when there is no default Konnector for the location. |
Error, not customizable. |
Billing provider is missing NPI number. |
This warning appears when the billing provider (whether added manually or auto-populated) is missing their NPI number. To fix this issue, either select a provider with an NPI or add the missing NPI number to the current provider.
|
Customizable |
Building is missing |
This warning appears when no building is selected for a billable item in a location where the Billing By Building feature is enabled.
|
Error, not customizable. |
CCode/RCode is missing. |
This error sometimes occurs for per diem items missing authorization. For outpatient items, this issue occurs if the clinician did not select a service. To correct the issue:
|
Error, not customizable. |
Claim Format is missing. |
This error occurs when a billable item has codes present, but no claim format. Ensure that the billable item has a claim format selected. |
Error, not customizable. |
Clinical LOC is missing. |
This error occurs when no clinical level of care is documented on the patient's chart. A clinical LOC is required if the patient's payment method is set to a payment category of Private Pay or Non-Insurance. If the patient has insurance, ensure that the correct payment method is chosen. To resolve this, ensure the Payment Method is set up correctly in the Patient Settings as seen below. Choose a different option or update the Patient Settings. Also, ensure a payment method is selected on the Facesheet. Navigate to the patient chart, and confirm a payment method has been selected. Note: for Private Pay workflows, please refer to Transmitting Billables for Private Pay/Non Insurance Patients |
Error, not customizable. |
Date of service is after discharge date. |
This generally occurs when there is a discharge date present. Please update the discharge date, the date of the service, or mark the item Do Not Bill.
|
Customizable. |
Date of service is before admission date. |
To resolve, please review the patient's Admission Date. If the date/time is after the Start Time of the billable item, please update. If the Admission Date is correct, review the billable item. All billable evaluations should include the evaluation_start_and_end_time field to appropriately set the start and end times of the service and calculate duration. If you are using a legacy form with the evaluation_date field, this will automatically default the start time to midnight on the day in question which will lead to this error. Please update the form to use the evaluation_start_and_end_time field going forward. |
Customizable. |
Diagnosis code is missing. |
This issue generally occurs when no diagnosis code is present on the patient's chart. To resolve the issue, edit the facesheet and add the Diagnosis.
|
Error, not customizable.
|
Incomplete items on this date. |
This issue occurs if the attached documentation for that billable item is missing signatures. To resolve the error, navigate to the patient's facesheet, click on the edit pencil icon, then change the service review status to the correct status. The patient has an open evaluation or group session that has not yet been signed for this date. Once all required signatures are added to the session/eval, this alert will go away. |
Customizable. |
Insurance has been deleted from Payor Settings |
Verify active insurance coverage on the patient's facesheet. If there is an insurance mismatch, remove and re-add the payer on the facesheet, ensuring to update the authorization so the new payer is recognized. Additionally, check that the insurance has not been deleted by looking under Settings > Payors. | Customizable. |
Insurance is missing [x] |
The information specified in the alert is missing from the patient's insurance. Please navigate to the patient facesheet and update the missing information. |
Error, not customizable. |
Insurance is missing policy number. |
This item appears if the insurance is missing the policy number. To correct the issue, navigate to the patient's chart and add the policy number to the insurance. |
Error, not customizable. |
Insurance is missing subscriber address. |
This item appears if insurance is assigned to a billing report but is missing any part of the subscriber's address (i.e., street, city, state, and/or zip code). To correct this issue, navigate to the patient's chart, and ensure that all address fields are filled out in the insurance section. |
Error, not customizable. |
Level of care authorization is in denied status on this date. |
This warning appears on inpatient or attendance-based LOC authorizations when there is a denied authorization attached to a billable item.
|
Customizable. |
Level of care authorization is in new/pending status on this date. |
When there is a New or Pending Auth per diem Billable Item the system treats the item as an outpatient/ancillary item until there is an Approved Auth on File. This can cause the billing provider to not populate as expected and will use the billable provider based on the hierarchy. This will also cause the Claim Format to default to Professional. To correct the issue:
|
Error, not customizable. |
Level of care authorization is missing on this date. |
This error occurs when the DOS on the billable item does not fall under any authorizations that are set to Approved or Denied. This error can also occur if the Utilization Review (UR) is missing, expired, or has mismatched insurance. To correct the issue: Step 1: Check if the Authorization is Present
Step 2: Validate the Authorization If the LOC authorization is present, ensure the following:
Additional Notes:
|
Error, not customizable. |
Location is missing. |
This error occurs when the DOS on the billable item does not fall under any of the locations in the Location History on the patient's facesheet, which usually happens if the patient's admission date is backdated but the Location Date was not. It can also occur if the location is left blank or if the start date occurs before the patient was admitted. To correct the issue:
|
Error, not customizable. |
MAT doses included for future date. |
This generally occurs when dispensing for any future dates.
|
Customizable. |
Maximum number of units exceeded on this date. |
This error occurs when a Unit Billing payer rule has been configured and the Maximum Allowed Units are exceeded.
To correct the issue:
|
Customizable. |
New diagnosis code added on this date. |
This issue occurs when there are new diagnosis codes added to the patient after a default dx was established. You can review the diagnosis codes in the Edit Claim window or under the Diagnosis Codes section of the patient’s Billing tab. |
Customizable. |
Overlapping services occurred on this date. |
Validate that there are no overlapping dates for Billable and Billed Items. This issue appears specifically for ancillary-to-ancillary overlap OR non-ancillary services overlap on the same per-diem billable day. In the expanded view, the overlapping services will display a warning icon so that it is easy to identify which services are overlapping. |
Customizable. |
Patient program is missing. |
This error occurs if the DOS on the billable item does not fall under any of the programs in the Program History on the patient's face sheet. Additionally, sometimes the program that is selected on the patient isn't turned on for that location. To correct the issue:
|
Error, not customizable. |
Payment method is missing. |
This error appears when there is no payment documented on a payment per diem item.
|
Error, not customizable.
|
Required hours not met on this date. |
This error occurs when the configured required hours for that level of care has not yet been met for the day. |
Customizable. |
Service authorization is in denied status on this date. |
This warning appears on service authorizations when there is a denied authorization attached to the billable item.
|
Customizable. |
Service review insurance is missing external payor ID. |
This error occurs when a service authorization is applied to a billable item and that service authorization's insurance is missing an external payor ID. This ID is usually is required for third party systems.
Note: When updating the Ext Payer ID if prompted to "Update payor information on linked records?" please Accept and Update All.
|
Customizable. |
Please note that these lists of errors and resolutions are not exhaustive. Please contact Support if you need assistance resolving any billing report errors.
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