Override a Transaction Category and Payor
The display of the Transaction Category Override page varies, depending on the features that are enabled for your facility.
- With the Coordination of Benefits (COB) disabled, this page allows you to define each individual transaction on an account as either a primary or secondary transaction.
Note: This page limits to changes between categories IP and 2P (primary and secondary payment) or IA and 2A (primary and secondary adjustment). No other changes are allowed through this page.
- If Coordination of Benefits (COB) is enabled, this page is renamed to the Transaction Payor Override and allows you to override the payor for the transaction, but not the transaction category. Because COB provides additional features for secondary and tertiary payors, it is not necessary to categorize transactions as secondary. For more information about COB, refer to Coordination of Benefits.
Use this procedure to override a transaction category or payor on an account.
Procedure
- Access the Transaction Category/Payor Override page.
If you know the account number:
- Select Go To > Account Research > By Account Number. The Account Research by Account Number page opens.
- Type the account number and click Display Account. The Patient Account Audit page opens.
- Click A/R in the View column. The Payments and Adjustments page opens.
- Click Update Transaction Category/Payor. The Transaction Category/Payor Override page opens.
If you do not know the account number:
- Select Go To > Account Research > from Worklist. The Account Research from Worklist page opens.
- From the Task list, select Create Worklist.
- Specify other selection criteria and click Display Accounts. The Account Worklist page opens. For more information about search criteria, refer to Specify Account Worklist Criteria.
Note: PEM claims are not included in worklist results.
- Click the account number you want to review in the Account Number column. The Patient Account Audit page opens.
- Click A/R in the View column. The Payments and Adjustments page opens.
- Click Update Transaction Category/Payor. The Transaction Category/Payor Override page opens.
- Select the check box for the transaction you want to override.
- The Current Category column shows the current category for the transaction.
- The Change to Category column shows the category the transaction will change to if you select the check box and click Override Category. This column does not display if COB is enabled for your facility.
- You can select multiple transactions to override several at one time.
- Type a comment explaining the reason for the override or any other relevant information in the Comments column.
- If the plan ID is changing as a result of the override:
- If COB is not enabled for your facility, type the new plan ID in the New Plan ID column.
- You can change the plan ID only for the transaction if you are also changing the category.
- If COB is enabled for your facility, select the new plan ID from the Plan ID (Payor Class) list.
- If COB is not enabled for your facility, type the new plan ID in the New Plan ID column.
- Click Override Category or Override Payor. Your changes are saved, and the View Transaction History icon appears in the Description column.
Field DescriptionsThe following table describes each of the fields on the Transaction Category Override page. The fields are listed in alphabetical order.
For detailed descriptions of the summary sections, refer to the following:
Field | Description |
Amount | Dollar amount of the transaction |
Balance | Billed Charges, minus payments, minus adjustments |
Change to Category | Category the transaction will change to if you select the check box and click Override Category |
Comments | A text field that allows you to explain the reason for the override or provide any other relevant information |
Current Category | Current transaction category for the transaction |
Current Plan ID | Current plan ID associated with the transaction. If Coordination of Benefits (COB) is enabled for your facility, the payor class (Primary, Secondary, or Tertiary) displays in parentheses after the plan ID. |
Date | Date the transaction category was assigned or overridden. |
Description | Detailed description of the transaction code |
New Plan ID | Text field that allows you to enter a new plan ID and associate it with the transaction. If Coordination of Benefits (COB) is enabled for your facility, the payor class (Primary, Secondary, or Tertiary) displays in parentheses after the plan ID. |
Reprice Type | Indicates the reason the claim was repriced separately from other claims for this account. This column also helps to distinguish between multiple claims on an account. For more information about reprice types, refer to Multiple Reimbursement Calculations > Reprice Types. |
Select | A check box that allows you to select the transactions that you want to override |
Transaction Code | Customer defined A/R transaction code |
Links on the Payments and Adjustments Page- Master Account Audit displays the Master Account Audit page. For more information, refer to View the Master Account Audit Page.
- Account Audit displays the Patient Account Audit page. For more information, refer to View the Patient Account Audit Page .
- View Supplemental Billing History displays the Supplemental Billing History by Account page. For more information, refer to View Supplemental Billing History by Account.
- Add Reminder displays the Add/Update Reminder page. For more information, refer to Add or Update a Reminder.
- Add Communication Item displays the Add Item page. For more information, refer to Add a Communication Item.
- Return to Account Worklist displays the Account Worklist page. For more information, refer to View the Account Worklist .