Incorrect Procedures on Claim

Find below instructions on how to correct a Claim with errors on the included procedure codes, or attached providers.

Incorrect Procedure Codes on Claim


Note: Also follow these steps to correct procedures sent with the wrong treatment area or surface.


If you create a claim that contains incorrect procedure codes and have not sent it:

  1. Delete the Claim.
  2. Edit or delete the procedures.
  3. Recreate claim, then send it.

If you create a claim that contains incorrect procedure codes, send it, and then realize the error or the insurance company denies the claim:

  1. First make a Commlog entry in the account explaining why payment denied.
  2. Open the claim and change its status to Waiting to Send.
  3. Delete the claim.
  4. Edit or delete the procedures.
  5. Recreate claim, then send it again.

If an incorrect procedure is submitted to insurance, insurance pays and check is created, then insurance company requests refund:

  1. Open the claim.
  2. Select the procedure(s), then click Supplemental in the Enter Payment area.
  3. Enter a negative insurance payment (refund), then click OK.
  4. If a check needs to be written from the practice to the insurance company, write the check, but leave the entry out of the deposit if using a Deposit Slip.
  5. If the insurance company is subtracting payment from a check for other patients:
    1. Add an Adjustment to the patient's account. The amount should equal the fee charged minus the write-off (e.g. patient portion).
    2. When that bulk check that includes the negative payment is created, the amount will be correct. Deposit as normal.
    3. Do not change the write-off (if any) on incorrect procedure(s).
    4. Leave the date as today's date to preserve the record.
    5. The incorrect procedure should stay on record. Select the procedures, add a note that it was not done, and check the HideGraphics box.

    The reason the incorrect procedure needs to stay on record is that paperwork has been submitted to the insurance company and money has exchanged hands. Just removing it makes it harder to explain in the account and makes your reports incorrect. If you must leave the incorrect procedure because of a claim, just add and predate the correct procedure code after you have followed the steps above. Send the claim again as needed.

If you just need to change a procedure code and there is no claim attached, click Change on the Procedure Info window.

If an incorrect procedure is submitted to insurance, insurance pays and requests a corrected claim:

  1. Commlog or notate on the claim that a corrected claim is necessary.
  2. For the incorrect procedures on the original claim, create an adjustment to adjust off the procedure amount. This will zero out the procedure fee.
  3. Chart the correct procedures for the original date of service.
  4. Create a new claim with the corrected procedures and service dates and send to insurance.
  5. We recommend contacting insurance to discuss any potential refunds.

Incorrect Providers on Claim Procedures


If the claim is sent to insurance and then you realize the provider on the procedures is incorrect, we recommend calling the insurance carrier to see if this can be fixed over the phone, or if they require a corrected claim.

If you create a claim that has the wrong provider attached to procedures and have not sent it:

  1. Delete the claim.
  2. Edit the procedures to assign the correct providers.
  3. Recreate the claim, then send it.

If you create a claim that has the wrong provider attached to procedures, send it, and then realize the error, or the insurance company denies the claim:

  1. If necessary, create a Commlog entry in the affected patient account explaining why the payment was denied.
  2. Open the claim and change its status to Waiting to Send.
  3. Delete the claim.
  4. Edit or delete the procedures to use the correct providers.
  5. Recreate the claim, then send it.

If an incorrect provider on a procedure is submitted to insurance, insurance pays and requests a corrected claim:

  1. Commlog or notate on the claim that a corrected claim is necessary.
  2. For the incorrect procedures on the original claim, create an adjustment to adjust off the procedure amount. This will zero out the procedure fee.
  3. Chart the procedures with the correct provider for the original date of service.
  4. Create a new claim with the corrected procedures and service dates, and send to insurance.

If an incorrect provider on a procedure is submitted to insurance, insurance pays, and then is able to correct the provider over the phone:

  1. Double-click on the procedure and change the Provider.
  2. Open the claim and double-click on the claim procedure. Edit the Provider on the claim procedure, if needed.
    Note: If this is not allowed, go to Chart Module Preferences and check the preference Do not allow different procedure and claim procedure providers when attached to a claim.
    • Checked: When you update the Provider on the Edit Procedure window, as long as the claim is marked as Sent rather than Received, it will update the Provider on the claim procedure as well.
    • Unchecked: You will be able to change the providers on the Procedures but not on the claim procedure.