CUSTOM CLAIM VALIDATION EDITS
This article will provide some common claim validation edits and how to enter them at the procedure code set up.
97110 requires modifier GP when billed to Medicare
Fee Group Required based on Medicare Financial Class.
Setup > Procedure Codes > 97110 > Default > Modifier > GP
Radiology Codes must have modifier TC – Medicare
Fee Group Required based on Financial Class.
Setup > Procedure Codes > [Enter Radiology Codes] > Defaults > Modifiers > TC
New radiology codes must have modifier TC – Medicare
Fee Group Required based on Financial Class.
Setup > Procedure Codes > [Enter New Radiology Codes] > Defaults > Modifiers > TC
J3260 - 1 unit equals 80 mg
Setup > Procedure Codes > J3260 > Fees: Per Unit Fee, Units 1
88305 to Medicare must be changed to G0416
Fee Group Required based on Medicare Financial Class.
Setup > Procedure Codes > 88305 > Billing > Billed As > G0416
