Billing Group Logic Added for UB04 Claim Type

What’s New

• Billing Entity Selection is now available per payer level (Primary, Secondary, Tertiary) on UB04 claims.
• Billing groups will be filtered and shown in the dropdown based on the following matching criteria:
  • Plan/Payer: Must match the payer on both the billing group and the charge.
  • Location: Must match between the billing group and the charge.
  • DOS (Date of Service): Must fall within the billing group’s defined date range.
  • Charge Type: Must be set to UB92.
• When all criteria are met, the Billing Group will appear in the dropdown.
• The user can select from eligible options, or the system can auto-select a billing group using the same logic as implemented for Professional Claims.

Additional Enhancements:

• A value labeled “Specified Billing Provider” is included in each billing entity dropdown.
• The Provider section now dynamically reveals the appropriate dropdowns based on payer selection:
  • Primary insurance → Shows Primary Billing Entity dropdown
  • Secondary insurance → Shows Secondary Billing Entity dropdown
  • Tertiary insurance → Shows Tertiary Billing Entity dropdown

Consistency with Professional Claims:

• The overall logic and behavior mirror the Professional Claims implementation to ensure a seamless user experience and reduce training efforts.