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Claim Creation Window - Split Reason

Most offices prefer to have all of the patient's procedures on a single claim being filed. However, claims will sometimes need to be split into multiple claims.

How can I tell if my claim is being split?
When you generate a claim, you're taken to the claim creation window. You can tell if there are multiple claims that will be generated by the line listed for each claim. You can also see "x claims will be created" on the top left of the claim creation table as shown in the below screenshot.
If you scroll to the right, There is a column far to the right, "Split Reason" displayed in the below screenshot. 

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Reasons for Split Claims
There are several reasons why charges would split into multiple claims. If any of the following information differs between charges, separate claims will be generated.

  • Different Insurance: This would occur if the patient has charges from January and insurance that was active up until January 31. They also have a procedure from February and a new insurance on their account active February 1. While you select both charges, they will split into two claims. 
  • Different Provider ID: This can happen when you have different a provider listed in each charge window.
    • This can be resolved by selecting the same provider under the "Provider Shown on Claim" menu of the charge window.
  • Different Office ID: This will occur if you have different Offices listed in the charge window for each procedure listed on the claim.
    • To fix this, simply go back to the ledger open each charge listed on the claim, and make sure the Offices match.
  • Different Referral ID: This will happen when you have different referrals selected on each charge listed on the claim.
  • Different Demonstration Code (Listed in the Code's Fee Schedule): This split reason will happen when you have several codes on your claim with different Demonstration Codes
    • To fix this, be sure that the demonstration codes are correct. If not, update them and create a new claim. If these codes are correct and are required by the payer, it is best to keep the claim split.
  • Different Facility ID: This will happen when you have several procedures on the claim with different Facilities listed. 
    • This can be resolved by removing the other facilities, or making sure all of the facilities match between the procedures. You can also go to the MacPractice menu > Preferences > Forms > Check "Create as Few Claims as Possible".
  • Different Lab ID: This can occur when there are different labs listed on each procedure listed on the claim.
    • This can be fixed by removing or editing the Lab listed in the charge window.
    • Or you can go to the MacPractice menu > Preferences > Localization > Check "Do Not Split Claims for Different Labs".
  • Diagnosis code count greater than 12 on a paper claim or an eClaim:
    • This will happen when you have more than 12 diagnosis codes listed in the charge window for the procedures on the claim.
    • This can be fixed by editing/removing the unneeded Diagnosis codes. You can also go to the MacPractice menu > Preferences > Forms > Check "Create as Few Claims as Possible".
  • Maximum Proc Count: If a claim has more procedure codes than there are lines available in a claim form, the claim will be split in order to accommodate all procedure codes.
    • There is not a way to fix this one, if you need all of the selected procedure codes sent out on a claim, it would be best to do so on multiple claims. 

Preferences that control Claim Splitting

  • In Preferences > Forms: enable "Create as Few Claims as Possible" With this checked, MacPractice will not split claims for the number of procedures, number of diagnosis codes, referral, or facility. 
  • In Preferences > Claims: there is an option to Optimize for fewest claims when using eClaims. 
 
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