Add Claim Override Data

Once you determine the account number and value you want to override, you must verify that the claim information is correct and provide the override data to save the change.

Use this procedure to verify the claim information and add an override value and comment about the change to a particular claim.

  1. Access the Claim Override Verification page.
    1. Select Go To > Overrides > Claim Override Add. The Add Claim Override page opens.
    2. Type the number of the account you want to override in the Account Number field.
    3. Select the type of value you want to override from the Field Types list. For more information about searching for a claim, refer to Specify a Claim to Override.
    4. Click Add Claim Override. The Claim Override Verification page opens.
  2. Review the claim information to ensure the displayed claim is the one you want to override.
  3. Type a new value for the field you want to override in the Override Value field.
    • If you are forcing a reprice or voiding the account, you do not enter a new value.
    • If you are overriding a primary procedure code, you must type an ICD-10 code for the new value.
    • If you are overriding a payor code, the new code must match one of your existing payor codes exactly. To look up your list of payor codes, refer to View Payor Mapping by Payor Code.
  4. Type a reason for the change in the Comment field, or follow your internal procedure for such comments.
  5. Click Save Claim Override.

The following table describes each of the fields on the Claim Override Verification page.

Field

Description

Account Number

Patient account number (for UB claims) or insured ID (for CMS-1500 claims)

Admit Date

Date of admission for the account

Bill Type

Bill type

Comment

Comment typed by user who created the override

Dates of Service

The range of date of Service From and date of Service To for the claim

Discharge Date

Discharge date

Discharge Status

Discharge status value

Entry Date

Date the claim was entered into Contract Manager

Field to Override

Name of the field that is to be overridden

Latest Account Override Made On

Date of the previous override

Latest Claim Override Made By

User ID of the individual who performed the last account override

Latest Claim Override Value

Last value added by override

Old Value

Value of the field before the override

Override Value

New override value

Patient Type

Patient type assigned to the account: Inpatient/Outpatient

Payor Code

Payor code associated with the product

Payor Name

Name of the payor

Service Start Date

First date of service rendered to the patient

Submit Date

Date claim was submitted