837 Outbound Re-Billing Service Assignment

Assign services that have been claimed to be re-billed on an 837 Professional or 837 Institutional bill.

1. Go to: Avatar MSO > Claims Processing > 837 Outbound Re-Billing Service Assignment
2. In the Member ID field, enter the member name.
3. In the Add/Delete field:
   • Select Add Claim To Re-Bill to re-bill services that have been claimed.
   • Select Delete Claim From Re-Bill to remove a service re-bill assignment claim that was created in error.
4. In the Claim Number field, select the claim number.
5. In the Service Inclusion/Exclusion Default field:
   • Select Include All to pre-select all services in the Select Service(s) For Re-Billing Screen.
   • Select Exclude All to have no services selected when the Select Service(s) For Re-Billing Screen is opened.
6. Click Select Service(s) For Re-billing to display the Select Service(s) For Re-Billing Screen.
7. This screen displays services associated with the claim. Select the services, click Ok.
8. In the Billing Form field, select the 837 Professional or 837 Institutional file for re-billing.
9. In the Claim Submission Reason Code field, select the reason for re-billing:
   • Select Corrected (Adjustment of Prior Claim), Replacement (Replacement of Prior Claim), or Void (Void/Cancel of Prior Claim).
10. Claim Original Reference Number field, enter the information to populate the Loop-2300, Segment-REF, Original Ref Number of the 837 file.
11. Click Display Re-Bill Information to generate the Electronic Re-Billing Service Assignment report.
    The report displays re-bill information entered in this form.

12. Click Submit.

► Registry Settings

• Claim Submission Reason Codes
• Enable 837 Outbound Version 5010
• Enable Pay-To Provider Name (2010AB)
• Require Claim Original Reference Number