Rebilling Claims without Fee Changes

Complete this task, also referred to as a Rebill 2, to generate a new claim with updated information on the case that does not affect the original amount billed. For example, rebilling a claim with new patient or guarantor information such as the Member ID or Subscriber ID. Other instances a Rebill 2 may be necessary include:

Adding a secondary insurance on the case
Adding an NPI number if none was entered previously
Modifying patient demographics, payer ID, coverage or insurance type
Entering valid diagnosis codes on the case if the previous codes entered were found to be invalid
Editing existing concurrency modifiers
Resubmitting the original claim with no changes of any kind
Creating a new insurance and re-ranking non-primary insurance records in the following scenarios:
1. Service fee contains a primary payment
2. Service fee contains a secondary claim for a different insurance
Rebilling multiple claims (Mass Rebill)

You do not have to perform a rebill if you are only updating the Case Reporting Type field on the General Case Information tab. This field can be updated anytime, regardless if the case has been submitted or saved.

When you rebill the service line with no fee changes, the original case is displayed on the Rebill page so that you can modify any information in the case that does not affect fees. You can then rebill one or more of the service lines in that case. When rebilling claims using this rebill type, responsibility of each service line rolls to the target payer.

The description of the original CLAIM sub-entry is changed to Cancelled Claim. The REBILL sub-entry is created for the SVCFE line with the new CLAIM sub-entry for the same charges and the replacement claim.

Fees are not recalculated, even if the underlying fee schedule has changed. Concurrency checking is excluded from the error checking process.

Step-By-Step Guide

Step

Instructions

Additional Information

1

From the Act: [ID] > Active AR tab of the account with the claim to rebill, click the sub-entry of the claim to rebill.

You can click any of the following sub-entries for the SVCFE transaction code:

CLAIM-E (electronic claim)
REBILL-E (rebilled electronic claim)
CLAIM-P (paper claim)
REBILL-P (rebilled paper claim)

2

Click Rebill. The Rebill Type window opens.

3

Select the Rebill Service Lines on a Case without Changing Fees option.

4

Click Next. The Rebill page opens with the case information from the original claim.

5

Modify the pertinent information on the case.

You can only modify the information in the case in the case that does not affect service fees, for example, patient or guarantor information or the Member ID of the subscriber. The information that cannot be modified is grayed out.

What can be changed

Where to enter it

Patient

Guarantor

Pre-Auth #

Referral #

Patient, Guarantor & Insurance tab

Use the Modifying Patients, Guarantors & Subscribers task. Also, use this task to update the patient personal information, for example social security number and marital status.

Insurance section on the Patient, Guarantor & Insurance tab

Subscriber ID

Member ID

Group ID

Coverage Confirmed

Referral Numbers

Update Insurance window

Use the following tasks:

Recording insurance information
Recording Referral Numbers

General Information

Referring Physician

Hospitalization Dates

Disability Dates

Patient Details

Paper Claim Local Use Fields

Work Comp/Accident Information

Medicare Secondary Insurance Type

General Case Information tab

Use the following tasks:

Recording General Information
Recording the Referring Physician
Recording Hospitalization Dates
Recording Disability Dates
Recording Patient Details
Recording Additional Information for Paper Claims
Recording Accident Information
Recording Medicare Secondary Insurance

Type of Service

Procedure Description (Override Procedure Description)

Modifiers

ICD-9 Code/ICD-10 Code

NDC

Place of Service

Procedures & Provider Time tab on the Update Procedure window

Use the following tasks:

Modifying Procedures
Adding or Updating Diagnosis Codes

Additional Dates

Reason for Delayed Submission of Claim

Signature & Release

Programs & Exceptions

Additional Identifiers

Additional Case Information tab

Use the following tasks:

Recording Additional Dates
Recording Reason for Delayed Submission of Claims
Recording Signature & Release Authorizations
Recording Programs & Exceptions
Recording Additional Identifiers

Outcomes

Outcomes tab

Use the following tasks:

Adding, Editing, or Removing Outcomes from a Case

Notes

Notes tab

Use the following tasks:

Creating Case Notes
Reviewing Notes

6

After finishing modifying the case, click Next. The Rebill To window opens.

7

In the Rebill To column for each service line to rebill, select the payer to which the claim will be resubmitted.

You must specify a payer or plan on at least one service line.

8

Click Save & Rebill. The Rebill To window closes.

The claim is automatically submitted and is listed on the appropriate Claims page, either Electronic or Paper. A new claim is generated and the account is updated on the Active AR tab as follows:

The description of the original CLAIM sub-entry is changed to Cancelled Claim.
The REBILL sub-entry is created for the SVCFE line with the new CLAIM sub-entry for the same charges and the replacement claim.