Adding line items with appropriate service codes, fee modifiers, and diagnostic codes:
All claims submitted to Alberta Health will require a service code. The majority of service codes require at least one diagnostic code and may have up to three fee modifiers that can be claimed.
The service codes and diagnostic codes fields are searchable by code or by description so typing numbers or letters in these fields will automatically display search results. Codes can be selected from the search or typed in. Fee modifiers that are displayed once a service code is selected are the only modifiers that are applicable to the service code.
In order to complete a line item, follow these steps:
- Step 1: input the appropriate service code. You can search for the code by number or description. For longer descriptions, hover over the short description in order to see the full text.
- Step 2: complete the calls and encounters fields, if applicable. Calls signify time increments and act as multipliers to fee amounts, while encounters signify a specific visit with the patient when multiple visits are made on the same service date.
- Step 3: add any applicable fee modifiers (up to three). The list of fee modifiers that appear in the search results will be the only modifiers that are applicable to the particular service code chosen.
- Step 4: input the appropriate diagnostic code(s). You can search for the code by the number or the word.
- Step 5: select the service date. By default, the service date is set to today’s date. In order to select a service date in the past, use the calendar feature.
- Step 6: click the black “Add” button to add the line item to the invoice.
Please note that there is an “Extra fields” area to enter different claimed amounts when
appropriate. As well as add Supplemental Text to that service code (max of 73 characters).
You can add as many line items as you’d like for a particular patient. Different line items will be treated as separate invoices by Alberta Health and will be assessed based on the service code and service date.
Adding any additional information to the claim:
Any other information that may be required in a claim can be set in the Advanced tab on the invoice creation page. This is where any supplemental text (max 73 characters) can be added, as well as where certain indicators, for example, the newborn codes. This is also where specific claim information for a particular claim can be changed, such as facility number and functional centre, secondary skill code, hospital admission date, and more.
The Demographics tab next to the Advanced tab holds extra information about the service recipient, payee, and referring service provider. This tab is used particularly for out-of-province patient billing where much of the information will auto-fill based on the data saved to the patient’s record.