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.
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
- Different Office ID
- Different Referral ID
- Different Demonstration Code (Listed in the Code's Fee Schedule)
- Different Facility ID
- Different Lab ID: There is a preference available to disable splitting because of Labs. A localization setting allows charges with differing labs to be included on the same claim.
- Diagnosis code count greater than 12 on a paper claim or an eClaim
- 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.
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.