Reset Ins Billing - Line Item

Insurance Payment Entry is the principal means for performing line-item refiles.  However, it is likely that some miss-paid line-items will not be refiled by the payment entry staff like they ought to be.  Therefore, another way of performing a Line-Item Refile needs to be available.  Reset Ins - Line Item will restart the billing at a specific insurance level for specific line items.

The old claim "billing record" will be closed.  Since the reset billing will be a new claim the aging will restart if there were previous claims open.  Important:  The Reset Ins Billing - Line Item option resets particular charge(s) on a visit.

Once you select the Reset Ins Billing - Line Item option, select the Coverage Type: Regular, Workers Comp, No-fault Auto or Other.  As noted on the screen, if necessary, you may change the coverage type here. However, please note that charges will NOT be recalculated with new billed or allowed Fee Schedules, Rate Structures, Units, Quantities, etc. If you wish to update these fields, you must Reverse, Reissue, and Re-post the Visit using the appropriate Coverage Type.  Reset Billing will, however, update the Medical Direction modifiers to the ones required by the new plan, or remove the modifiers from the MD and CRNA modifiers if the new plan does not use Medical Direction modifiers.  Reset Billing will remove the visit from Collection Turnover (if it is in Collection Turnover).

A red message is displayed in the Reset Billing screen beside the "Force Refile To" field alerting the user that leaving the field BLANK will allow the system will file the new claim according to the Patient Insurance Setup.  The user should only utilize the Force Refile To field if OVERRIDING the plan setup.  For example, if a plan is set to file claims electronically but you need to attach additional documentation to have the claim paid, select PAPER in the "Force Refile To" drop down.  In most instances the user should leave this field blank to file the claim according to the plan setup.

Select the insurance plan to reset the billing on for each charge and then choose OK. The Billing View of the ledger will display a new claim billing record in light blue as un-posted.  This means the new claim will generate in the nightly closeout.