Claims guidance: updating inpatient and outpatient bill types

Understanding how to update claims to bill inpatient and outpatient services accurately ensures prompt reimbursement, improves quality reporting, and increases patient satisfaction by mitigating unexpected costs. Please use the guidance below.

Replacement of inpatient bill types

When a claim is mistakenly billed as an inpatient bill type, it must be replaced using the ‘replacement bill type’ xx7. To correctly replace an inpatient bill type, the replacement must match the same bill type category:

• Replace x11 with x17
• Replace x31 with x37
• Do not replace x11 with x37, or x17 with x31.

Changing between inpatient and outpatient bill types

To change billing from inpatient to outpatient or from outpatient to inpatient, follow these steps:

1. Void the incorrect claim using ‘frequency type 8’ to avoid errors and overlaps.
2. Create a new claim submission labeled ‘frequency type 1’ to represent the correct billing type.

Contact your network manager or provider relationship management representative with any questions.