Institutional Claims: Set Up and FAQ

These settings and processes are specific to Self-Service Members. 

Proper billing of Institutional Claims (Medicare Part A/UB-04) is dependent on Payer setup. 

Let’s start by adjusting the Payer’s Company Specific Overrides to ensure claims are billed to the correct payer group and frequency. 

  1. Open the Billing menu and select Payers.
  2. Use the search criteria to locate the correct institutional payer. Double-click to open.
  3. Review the Payer Group field in the Cross-Company Settings. If you see “Medicare…” listed here, you’ll need to update the payer group so that it goes out through Change Healthcare or Waystar depending on the clearinghouse you use.
  4. In the Company Specific Overrides card, choose the correct clearinghouse and frequency combo from the Payer Group drop-down.
    1. Change Healthcare Institutional Monthly: Choose this payer group to electronically submit claims on the 3rd business day of each month.
    2. Change Healthcare Institutional: Choose this payer group to electronically submit claims daily.
    3. CORF UB-04 Daily: Choose this payer group to send these claims to paper daily. These can be printed from the Batch Billing page.
  5. You may also need to update the Inbound IDs and Outbound ID fields. These can be gathered from Change Healthcare’s payer list. 

Institutional Claims: EMR FAQ

Which settings are required in the WebPT EMR in order for claims to bill correctly?

There are no settings required to bill UB-04 out of the EMR at this time. There is a project in development that will pull the correct MSP, Clinic, and Frequency codes onto the claim to increase clarity and consistency when billing Part A.

How should I set up my insurances in the WebPT EMR?

If you bill the same insurance for Part A and Part B, we recommend that you add the insurance twice with an identifier to tell them apart. This will make it easier to customize how each insurance bills out, saving some manual steps and making reporting cleaner. 

Institutional Claims: Billing FAQ

What status are the charges in until they bill?

Claims are held in C status, meaning the charges have finished the scrubbing process and are ready to bill.

Where are the charges held?

You’ll be able to view the charges on the Unbilled Aging report. 

Where are rejections worked and corrected claims submitted?

All EDI rejections and corrected claims must be worked and completed through the payer's DDE portal. 

Can I demand a claim?

Yes, you can demand a claim, just be sure to select Paper UB04 from the Format drop-down.

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