Overview
The Billing Matrix is designed to handle special billing code setups that differ from your standard configuration in PIMSY. It allows you to create exceptions (rules) when a billing code requires something unique, such as an insurance company that needs a specific modifier (or a different modifier than usual). With the Billing Matrix, you can set custom rules based on insurance company, user, billing code, or a combination of these factors.
Required Permissions and Prerequisites
- This article is in reference to our Desktop application
- Please assign the Create, Modify, View, and Delete permissions for the following rule(s):
- Billing Code Group
- Billing Matrix
- User Group
Step-by-Step Instructions
Step 1: Navigating to the Billing Matrix
From the top navigation menu, go to:
Financial > Billing Matrix
Step 2: Adding a Rule
From the Billing Matrix screen, click on the top row where it says "Click here to add a new row" and select a User, Insurance Company, and the Billable Code to set for the rule. Next, choose any additional items that apply, such as a Modifier, Billing Rate Per Unit, or other code-specific exceptions required by the selected insurance.
Enter a valid Start Date and End Date, then click Save.
To customize which columns are visible, right-click the blue grid header, then select Column Chooser from the menu. To pull a specific header down, simply click on the header, and while holding the button down on your mouse, bring it over into the header row, and release your button on the mouse.
Step 3: Using the Bulk Create Wizard
To add numerous codes for numerous users for a specific payer at once, you can use the Bulk Create Wizard, located at the top of the matrix.
Prior to opening the matrix, you will want to create a billing code group that has the codes you need to add the rule to, and create a user group that has the users that are impacted. After refreshing your pick list by going to the Utilities menu, and selecting Refresh Pick Lists, you can then go into the matrix.
In the wizard, enter the Insurance company, the billing code group, and the user group, followed by clicking Create. A series of prompts will display. Enter the information if it is a part of the set up, such as changing the rendering NPI or clicking OK to skip that data point. The only data point you must fill out when completing the Wizard is a start date and end date.
If you need to set the entries for a specific modifier or requires dual sign off, you can now go back and add those to each of the lines as they are displayed in the matrix. Click Save and exit the matrix.