Pended Charges (P)

The Pended Charges worklist shows charges in “P” status. These charges require a manual review and release. The system will flag any charges that come through and place them in the Pended Charges worklist if one of the following occurs: 

• The Audit Required checkbox is checked on the Insurance Class.  
  
• The charges fail to meet a specific rule in the system's Charge Edits (e.g., manually scrubbing codes or procedures listed on the CPI forms.) 

Let's review how to work charges on this worklist.

1. Open the Charges menu and select Charge Audit.

   

2. To view the Pended Charges, click the Charge Count under the Pended Charges (P) column.
   
3. Charge lines are grouped by Patient and Date of Service. In this example, you can see that the charge was flagged for Audit Required. 
4.  You can do one of three things with the date of service: 
   1. Pend: Any charges that you pend will automatically be placed on Delayed Claims. 
   2. Release: Any charges you release are sent through the scrubbing process to bill.
   3. Edit Visit: Any charges you edit and release will be sent through the scrubbing process to bill.

Pend Charges

If you notice anything that is incorrect or potentially needs further review, you can Pend the charges using the Release or Pend drop-down. Providers waiting on credentialing is one of the most common reasons charges are pended. Any charges you pend will automatically be placed in Delayed Claims.

1. Select Pend from the drop-down.
   
2. If Pend is selected, you must also indicate a Pend Reason for each Date of Service. For this example, we’ll select Pending Provider Credentialing Certification.
   
3. Click Save at the bottom of the window to process your selections. 
   

   Important: If you are working through multiple charges, make sure to Save your changes on each page before moving on to the next. All changes will be lost if you do not save. 

Release Charges

If the billing guidelines have been met and no changes are needed, release the charges. All released charges are sent through the scrubbing process to bill.

1. Select Release from the dropdown and click Save.
   
2. If a previously released charge reappears on Pended Charges and you’ve confirmed it meets all billing guidelines, select Release and choose Approved by Auditor from the Pend Reason drop-down.
   
3. Click Save and the charge will release from the Pended Charges worklist.

Edit Charges

Charges can be edited directly in the Pended Charges (P) worklist. For example, if a member has guidelines to change a specific CPT code or to bundle codes together, those edits can be made here. Please reference your billing guidelines for each contract carrier. 

1. On the Charge Audit page, select the Charge Count under Pended Charges to work this queue.
2. For low-level audits, utilize this main screen to make edits to CPT Codes, Units, or Modifiers. For high-level audits like editing or adding charges, click Edit Visit.
   Important: A Payment Icon ( $) will display next to the Date of Service once a payment has been posted on one or more charges. On the main screen, the NC - NO CLAIM modifier will not be available. When you go into Edit Visit, the row itself will be grayed out and you will not be able to make any changes.
3. Under Charge Detail in the Edit Visit page, enter the corrected charge into the Amount field. Once you have made your changes, click Save and you will return to the Charge Review worklist.
   1. If you need to add a charge, stay on the Edit Visit page and click the Add Charge button to fill out the new line. We recommend that the therapist add an addendum to the patient’s documentation if new charges need to be added. This ensures the documentation supports the charges billed.
      

   2. To remove a charge, select the  checkbox under Status and click Remove Charge.

   3. Once you’ve made your changes on the Charge Detail screen, click Save.
      
4. Back in the Charge Review worklist, click Add Account Note to document your actions and the note will appear on the patient’s home page under Account Notes.