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Services unexpectedly split into separate claims

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Resolution

If services are billed by rates that have same service line consolidation on the rate header they should produce a single claim with multiple service lines. There are certain conditions that will cause the services to be split into separate claims despite the matching service line consolidation:

  • If services have separate authorization details then they will always split into separate claim. As of version 8.5.18 we introduced ability to link service bundle on authorization details. This allows you to have a single authorization detail that links to multiple services and will allow the services to consolidate into single claim. You can read more about that in the attached document.
     
  • If one of the rates is flagged to break when service facility changes while the other is not then this may cause the claims to break - even if service facility is the same for all services. This flag should be unchecked for all rates involved.
     
  • If the accounting information is not the same for each program/service/rate then you cannot cannot consolidate into a single claim.
     
  • If one of the program/service/rates is flagged that co-pay applies while the other is not then you cannot consolidate into a single claim
     

Please see AuthDetailsServiceBundle.docx for additional information.