Differences

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--- guides:manual-claim-entry [2026/06/03 16:22] – DRG now captured; refine UB-04 unmapped-field note brad.sharp
+++ guides:manual-claim-entry [2026/06/03 18:12] (current) – Add outside-lab (Box 20/32) guidance + batch gate; FL29 now sent brad.sharp
@@ Line 33: / Line 33: @@
   * **Dropdowns for coded boxes** — boxes that take a specific code (for example, CMS-1500 Box 27 *Accept Assignment* and Box 31 *Signature*) are dropdowns so you don't have to remember the valid values.
   * **Service lines** — service lines are entered in a table. Click a line (or **Add Line**) to open the line editor, where you enter the procedure/revenue code, charge, units, and link diagnosis pointers using the diagnosis chips.
+> **Outside lab (CMS-1500 Box 20):** if you mark Box 20 and enter a charge, also enter the **outside lab's name, NPI, and address in Box 32 (Service facility)**. The outside lab //is// the service facility on the EDI claim, so its NPI is what carries the purchased-service charge. A claim with an outside-lab charge but no Box 32 service facility can't be submitted (see Step 6).
+===== Step 4: Validate =====
+Click **Validate** at any time to check the claim. If everything required is present, you'll see a green confirmation panel. If something is missing or inconsistent, the issues are listed in a panel so you can fix them before submitting.
+> **Good to know:** Validate checks the claim's data (required fields, payer number, and so on). Some deeper structural checks happen later, during processing — so it's still a good idea to watch the claim's status after you submit. See **Known Limitations** below.
 ==== Attaching the source document (optional) ====
@@ Line 41: / Line 49: @@
   * The attached document can be viewed alongside the form while you key
   * You can remove it again with the **delete** option
-===== Step 4: Validate =====
-Click **Validate** at any time to check the claim. If everything required is present, you'll see a green confirmation panel. If something is missing or inconsistent, the issues are listed in a panel so you can fix them before submitting.
-> **Good to know:** Validate checks the claim's data (required fields, payer number, and so on). Some deeper structural checks happen later, during processing — so it's still a good idea to watch the claim's status after you submit. See **Known Limitations** below.
 ===== Step 5: Save =====
@@ Line 62: / Line 64: @@
 The selected claims are converted to the correct format (837P for CMS-1500, 837I for UB-04) and sent for processing.
-> **A payer number is required.** If a selected claim is missing its payer number, it will be blocked from the batch and called out so you can fix it. Use **Look up payer** on the claim to set it.
+> **Some checks block a batch.** A claim is held back (and called out) if:
+>   * it has **no payer number** — use **Look up payer** to set it; or
+>   * **Box 20 (outside lab)** has a charge but **Box 32 (service facility)** has no NPI — add the outside lab's details in Box 32.
+> Fix the flagged claim and submit again.
 ===== The Advanced Editor =====
@@ Line 75: / Line 80: @@
   * **Secondary / coordination-of-benefits (COB) claims are not supported here.** Key the primary claim, then use the full claim editor to complete a secondary claim.
-  * **A few less-common UB-04 fields aren't on the form yet** — occurrence //span// codes (FL35-36), additional procedure codes beyond the principal, and other-operating / other-provider fields (FL78-79). If you need one of these today, use the **Advanced editor**.
+  * **A few rarely-used fields aren't on the form** — e.g. other provider (UB-04 FL79), responsible party (FL38), employer name (FL65). If you need one, use the **Advanced editor**.
   * **Two-layer validation.** The in-form **Validate** confirms your data is complete; some structural checks run later during processing, so a claim that validates can still need attention after submission. Watch the claim's status.