Set Up Procedure Code for Institutional Claims

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Path: Maintenance and Setup > Procedure Codes > Procedure Codes

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Specific Procedure Codes can be set up so that they are sent to all payers institutionally rather than professionally. Or, some payers may want to see the Procedure Code professionally while others want it to be filed institutionally. Steps on how to set up Procedure Codes for these two scenarios are found below.

Set-Up Procedure Code as Institutional for All Payers

1. Navigate to the Master Procedures Codes List by following the path above.
2. Select the Procedure Code you wish to edit, and click the Ok button. If you are adding a Procedure Code for the first time, follow the steps here.
3. Click the Edit button.
4. In the 837 Format (P/I/D) field enter "I" for institutional.

1. (Optional) Select the CLIA ID Required checkbox to have the CLIA ID displayed on claims for the CPT Code.
2. Click the Save button.

Set-Up Procedure Code as Institutional for Some Payers

Add a new Procedure Code as you normally would by following the steps here, and set the 837 Format (P/I/D) field to a P for professional. Next, follow the steps below to add insurance-level Procedure Code institutional overrides.

1. Navigate to the Master Procedure Codes List: Maintenance and Setup > Procedure Codes > Procedure Codes.
2. Click the Override by Ins button.

1. Click the Ok button.
2. Click the Add button.
3. From the Proc Code ID drop-down menu, select the Procedure Code you want to set up as institutional.
4. From the Insurance drop-down menu, select the Insurance Payer this override is applicable to.
5. In the 837 Format field, type "I" for institutional.