Enable Extended Matching Criteria Functionality - Registry Setting
If you need to send claims through a state aggregator that submits claims to payors on behalf of all providers in the state, you can use Enable Extended Matching Criteria to assit you. Since the claims are not generated out of an EHR (in this case, myAvatar), they are not given a claim ID number by the EHR. The system then has no way to match the 835 to the services to allow for those 835s to post automatically. Instead, you would have to manually post your payments, and this can be time-consuming and cumbersome. Enabling this registry setting will allow for inbound 835s to match on criteria other than claim ID to allow for automatic 835 posting where possible.
Although this was developed with EVV billing in mind, this functionality can be leveraged for other billing scenarios as well.
| Option | Function | Notes |
|---|---|---|
| Y | Enables the 835 remittance process to use extended matching criteria to post payments to services that do not have matching claim numbers with the 835. |
Extended matching criteria is used in 835 remittance processing only when the myAvatar claim number is not included in the 835 file. This can happen when a third-party biller submits the service in the 837 file to the payor. Extended matching criteria includes both client and service elements. |
| N | Disables the above |
Client Elements (2 out of 3 must match):
- Client Name
- Subscriber Policy Number or Social Security Number
- Subscriber Name (if subscriber is not the client)
Service Elements (all 4 must match):
- Date of Service
- Cost of Service (SYSTEM.billing_tx_history.cost_of_service)
- Procedure Code/Modifiers
- Service code is flagged to be included in 835 extended matching criteria
If the above criteria are met, the 835 remittance process will post the payment and/or adjustment against the service. Otherwise, an error will be included in the 835 error report.