Set Up a Procedure Code Override for an Insurance Payer

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Path: Maintenance and Setup > Activity Codes > Activity Codes

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When setting up an Activity Code's insurance coverage, the information is set at the Party Type level (see Set Up an Activity Code for more detail). Sometimes, it may be necessary to enter in an insurance level override for a procedure code.

Procedure Code Override for an Insurance Payer

1. Navigate to the Master Activity Code List by following the path above.
2. Select an Activity Code.
3. Click the Ins Coverage button. The Activity Code Insurance List is displayed and lists all the Party Types associated with the Activity Code you've selected.
4. Select the Party Type.
5. Click the Override By Insurance button.

1. In the Activity Code Insurance Override By Insurance List, click the Ok button.

1. Click the Add button.
2. Select the Activity Code from the drop-down menu that you want to do an override for.
3. Select the Party Type from the drop-down menu that the payer belongs to.
4. Select the Insurance from the drop-down menu that the override is for.
5. (Optional) Enter an Effective From and Effective To date range.
6. Select a Billing Rate Code from the drop-down menu.
7. Select a Procedure Code from the drop-down menu that you want to attach to the Activity Code for the insurance you selected in step 10.
8. (Optional) Select a Modifier from the drop-down menu, if applicable to this Procedure Code. Remember, Modifiers in this window are additive to what you have set at the Party Type level.
9. (Optional) Select a Contact Type from the drop-down menu if this code should be billed to a different place of service than what is set in Contacts Billable.
10. Click the Save button.