Billing Settings - exports, diagnosis limits, delinquency, and duplicate CPT handling

Use Billing Settings to control how the LIS generates billing exports, how many diagnosis codes are allowed per claim, delinquency rules, and how to handle duplicate CPT scenarios. You can also add your online payments URL so it appears on patient invoices.

Important: Do not allow more than 12 unique ICD-10 codes per claim. Exceeding 12 can cause rejections.

Key options

• Diagnosis codes per claim
  • Set the maximum ICD codes the LIS will place on a claim (must be ≤ 12).
• Export mode
  • Export by Charges: the LIS translates tests, organisms, additional fees, etc. into billable CPT codes (recommended for automated billing).
  • Export per Tests: exports the ordered tests; the biller selects appropriate CPTs outside the LIS.
• Online payments URL on invoices
  • Enter the portal URL to print a payment link on invoices.
• Delinquency thresholds
  • Patients: mark accounts delinquent after N days.
  • Clients: mark accounts delinquent after N days.
• Remove transactions on hold
  • If allowed: users can manually remove items from the On-Hold queue.
  • If not allowed: users must process/resolve the transactions to clear the queue (recommended for stronger controls).

Duplicate CPT codes — choose a policy

Select how the LIS should act when an order produces duplicate CPT lines.

• Create Multiple Invoices
  • Splits the export/invoice to avoid duplicates on a single claim.
• Show Rejection Report
  • Blocks export and displays a rejection report with cues for correction.
• Allow if prices differ; otherwise split
  • Includes both CPT lines when their prices differ; if the prices are the same, create multiple invoices.
• Allow if prices differ; otherwise reject
  • Includes both CPT lines when their prices differ; if the prices are the same, show the rejection report.

Pick one approach that matches your payer rules and clearinghouse guidance.

📘 Instructions: Configure Billing Settings

1. Open Settings → Billing Settings.
2. Set “Diagnosis codes per claim” to a value ≤ 12.
3. Choose an Export mode:
   • Export by Charges or Export per Tests.
4. Enter the Online Payments URL to print on invoices.
5. Set “Patient Delinquent after N days” and “Client Delinquent after N days.”
6. Decide whether to Allow remove transactions on hold (enable/disable).
7. Under Duplicate CPT Handling, choose one of the policies above.
8. Save.

Best practices

• Prefer Export by Charges if your test-to-CPT mappings and additional fees are maintained in the LIS.
• Keep diagnosis codes ≤ 12 and prioritize them per payer guidance.
• Use delinquency days that align with your dunning schedule and state rules.
• To prevent silent data loss, disable manual removal from On-Hold and require processing.
• For duplicate CPTs, align policy with payer edits; many payers reject same-price duplicates on one claim.

Troubleshooting

• Claim rejected for too many diagnoses (unique ICD-10 codes): reduce to ≤ 12 and reorder by medical necessity.
• Missing CPTs in exports: verify mappings (tests/organisms/additional fees) when using Export by Charges.
• Online payment link not printing: confirm the URL field is populated and the invoice template includes it.
• Persistent duplicate CPT errors: switch to “Create Multiple Invoices” or “Show Rejection Report” and review test/CPT mapping.