Custom Rule in RM Not Working

Technical problems with Medisoft.
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mbpros
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Joined: Fri Mar 11, 2011 6:59 pm

Custom Rule in RM Not Working

Post by mbpros » Sat Oct 15, 2016 5:34 am

I have set up a custom rule in RM that if the payer is 01260 (Magellan Health) and the HP modifier is not in the Modifier 1 field for charges to return an error (see screen shot attached).

I tested this and for one patient listed 2 lines on a claim. The first line had the HP modifier; the 2nd one did not....But when I checked claims in RM, it did not return an Error Message as it should.

What did I do wrong with setting this up? I have set up other rules where the Payer Type is Medicare and an AT modifier or a GP modifier is required and that works, so not sure why this is not working since I do have the Primary Claims Payer ID correctly set to 01260 and I indicate that if the Charges, Modifier 1 is not equal to HP to return an error.

Thanks,
Steve
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Magellan HP Custom Rule.png
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Steven Zats
Medical Billing Professionals

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Gavin Walker
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Re: Custom Rule in RM Not Working

Post by Gavin Walker » Sat Oct 15, 2016 1:12 pm

It seems like it should work, but I don't see a way to specify an edit for just one of the charges versus any of them
Gavin Walker
Walker Tek Solutions, LLC
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mbpros
Posts: 312
Joined: Fri Mar 11, 2011 6:59 pm

Re: Custom Rule in RM Not Working

Post by mbpros » Sat Oct 15, 2016 1:22 pm

The edit should be reviewing all charges (all claim lines) so any idea how to do a rule that would review and ensure the HP modifier is on all claim lines? Only difference between this rule and other similar rules I have is that this looks at the Claims Payer ID whereas the other rules look at Payer Type (Medicare)...and the other rules work..
Steven Zats
Medical Billing Professionals

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Gavin Walker
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Re: Custom Rule in RM Not Working

Post by Gavin Walker » Sat Oct 15, 2016 2:48 pm

Try setting the condition to the type of the insurance to see if the edit at least works that way. And you do have 01260 in the Primary Payer ID field and that is different than your Payer Code field, right?

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