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837 Defaults Section

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Define 837 defaults for the contracting provider claims.
  1. The Require Exact Authorization Number selections should be evaluated by any organization that requires pre-authorization for professional and/or institutional claims. These settings help manage the validation between inbound claims and authorizations on file.
    • In the Require Exact Authorization Number(Institutional) field, select Yes to validate that the authorization number included in the inbound 837I is an exact match to an existing authorization for the contracting provider/client/service. If no exact and active match is found, the claim will deny.
    • In the Require Exact Authorization Number(Professional) field, select Yes to validate that the authorization number included in the inbound 837P is an exact match to an existing authorization for the contracting provider/client/service. If no exact and active match is found, the claim will deny.
  2. In the Support Population of Duration from 2400-SV1-04 field, select Yes to populate the duration from the segment 2400-SV1-04.​
  3. In the Require Claim Note (2300-NTE) (Institutional) field, select Yes to require the associated NTE segments to be included in the 837 Institutional file during the compilation process.
  4. In the Require Line Note (2400-NTE) (Professional) field, select Yes to require the associated NTE segments to be included in the 837 Professional file during the compilation process.
  5. In the Price the following CPT Codes as Single Unit field, select the CPT codes that will be calculated as single units.
  6. In the Price the following Procedure Code Group Definitions as Single Unit field, select the group definitions that will be calculated as single units.