Fix and Re-bill Primary Claims

There are a couple of reasons you would want to fix and rebill a claim. A couple of examples:

  • Add an authorization
  • Add modifiers, such as GP or KX
  • Change CPT codes

There are several ways to get into the claim.

  1. Patient's account -> Claims tab
  2. Billing tab -> Claims -> Search patient

Once you have made it to the claim you are needing to correct, you will want to click on the Heno Claim number:

On the inside of the claim, there is an Encounter button:

This will bring you to the Approved encounter. Click on the encounter number to enter it:

Click on the Re-Open button on the bottom right (Where the Apply Changes button usually is)

Once re-opened, you can manipulate inside the encounter.

To add an auth to the encounter you will need to make sure it is active in the account (There are some instances where it needs to be within a date range that includes today's date to add it to the encounter). Once you have that correct, you can click on the dropdown and select the auth to send.

If you are needing to change a CPT code or edit the modifiers on it, you will want to scroll down until you see the CPT codes. Click on the Edit Pencil to the left of the code:

In the pop up, you will be able to update several things.

  • Red - Allows you to update the CPT code
  • Blue - Allows you to update the number of united charged
  • Purple - Allows you to update the charged amount to the insurance
  • Yellow - Allows you to exclude from send (A reason this may be needed is for Creating an Additional Balance on a Claim)
  • Black - Allows you to provide an adjustment or a discount.
  • Lime - Reasoning for an adjustment or a discount can be given.
  • Green - Update Modifiers for this CPT codes
  • Orange - Update diagnosis codes. This will need to be switched in the Chart first
  • Light Blue - If you want to override the billed and allowed amounts that go to the insurance
  • Grey - If you need to add a line note to the encounter
  • Pink - Change the settings of the CPT code such as bill by minutes or emergency information

You will want to repeat with each code if adding the Modifyer until they are all updated.

Once you have completed your needs, you can change the status to Approved and Apply changes:

(Please note all Medicare claims need to go out as Original)

This claim is now in your send claims bucket:

Lastly, click submit for the type of claim it in (in this example it is a Print 1500 claim)