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Service did not bill and it should have

When a customer calls and says “an ‘xyz’ service did not bill and it should have”, there are multiple possible causes for this. While this is not an exhaustive list of causes, the following is a good place to start:

**First check to verify that an invoice does not already exist for this service, or that it does not appear in the billing edit list as a billable service if they haven’t posted billing yet

1. Is there a coverage record for the carrier being billed for the patient in question?

Note: If a patient's coverage changed, they may be expecting a service to bill to the “wrong” carrier

2. Is the service in question a billable service for that carrier?

Third Party Billing -> Edit Carrier Detail -> Modify Fee for Service Details -> Billable services are on the right

3. Is there a service of that type recorded in the case history?

Note: The service may have been entered under the wrong service type

Note: If the service they want to bill is not a case history service, then “~~” will appear before the letters of the id code:

~~DD = Dose history (dispensary dose)

~~TD = Dose history (takehome dose)

~~UA = UA history (ua history record)

4. Is the progress note saved complete?

Note: Only services that have been saved complete will bill

5. Was the service provided recorded with a “done date” that falls within the coverage start and end date

Note: When a note is entered, the “done date” automatically defaults to today’s date. If a note is being entered late, users often forget to change the “done date” to the correct date

6. Was the service provided recorded with a duration that meets the minimum units to bill requirements (see #2 for location of where to check that)?

Note: For case history entries, if the minimum units to bill is set to “1”, the service must be recorded with a duration of at least one minute

Note: It’s also possible that the minimum units to bill is not set up correctly in the carrier details

 

**If all of the above look fine, then proceed with the following:

7. Was the note entered AFTER billing was run? You can check this either by “printing” the progress note or running the following command and checking the “whenentered” field: select * from casehistory where seqnum = 9999;

If it was, then the service should be picked up the next time billing is run

8. Was the note modified after billing was run? (ie. they modified the duration after billing was run) If so, it’s possible the service was already marked for billing and won’t be looked at again unless the data is fixed:

a. select * from casehistory where seqnum = 9999;

Look at the “whenbilled” field, if it has a date in it, then it will need to be corrected so that it can be billed

b. update casehistory set whenbilled = null where seqnum = 9999;

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