eClaims - Value Code and Rate Code on Institutional eClaims

If Value Code and Rate Code are Needed on Institutional Electronic Claims
This document pertains only to institutional electronic claims. This information is not used on professional or dental eClaims.

Certain payers sometimes require a value code and a rate code on some institutional eClaims. Anthem Blue Cross of California, Blue Shield of DC, and New York Medicaid are the payers, known thus far, that are known to require value codes and rate codes on institutional eClaims. The Change Healthcare Payer IDs are ‘47198’, ‘SB580’, and ‘SKNY0’, respectively.

In order to pull the value code to an eClaim the actual value code needs to be entered into the claim details of the electronic claim, from the eClaims ability. Enter the value code under Claim > Value Code in the claim details, as depicted in the image below. There is not anywhere in MacPractice to enter and save this information, other than in the details of the eClaim itself.

The rate code can be entered into the charge, in the associated fee schedule. Once saved here, the rate code will remain associated to that specific procedure within that specific fee schedule.

If the rate code is information that shouldn’t be on all claim, or if it changes from claim to claim, the value can be entered in the claim details before sending. The rate code needs to be entered under the Procedure Node. From there, twist down the procedure that needs the rate code. Enter the code in the Rate Code field.

Once the value code and rate code have been added to the claim details, as shown above, press Command + S on the keyboard to save the information. Then send the eClaim.
Note: Once this information is saved within the claim details, do not use the rebuild feature before sending the claim. If the Rebuild button is pressed, this will clear the value code from the claim details. If the rate code was entered into the claim details manually, using Rebuild will also clear that information out. If the Rebuild button is pressed after entering these codes and before sending the claims, the value code and rate code will need to be re-entered into the claim details and saved before sending.

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