Create Invoice (Insurance)

Use the Create Invoice form to batch-bill orders across multiple patients. The system generates one invoice per order, and those invoices become insurance claims when exported to the clearinghouse in EDI format.

How it works

• Multi-order batching: Load eligible orders for many patients at once.
• One or more invoices per order: Each order can generate multiple invoices based on configuration (e.g., number of unique diagnosis codes per order—should not exceed 12, billing rules, duplicate CPT codes, CPT code incompatibilities) to reduce rejection rates.
• Grid-driven selection: Search, filter, group, and select precisely which orders to bill.

Workflow

1. Click Search to load billable orders.
2. Use advanced grid filters and grouping to refine results.
3. Review highlights: Yellow cells indicate missing required information.
4. Use Accepted/Rejected radio buttons to switch between orders that pass most checks vs. those needing corrections.
5. Select all orders to be billed.
6. Click Create Invoice to generate invoices (one or more per order).

More Options (main grid)

• Cases: Associate existing or new cases to selected orders.
• Documents: Attach supporting documents.
• Update Physician: Change ordering/referring provider.
• Set to No Charge: Flag orders as no-charge when appropriate.
• Add Fees: Add additional or travel fees.
• Update Billing Info: Edit Bill To, payer, policy, etc.
• Diagnosis: Add/update patient and order-level diagnoses.
• Internal Comments: Add audit notes.
• Rejection Report: Preview validation issues before invoicing.
• Manual Mode: Bypass billing and price rules for exceptions.
• Tags: Add tags for tracking/reporting.
• Recalculate: Re-apply billing and pricing rules after changes.

Pricing validation and rejections

• Common rejection causes:
  • Missing permitted diagnosis codes required for medical necessity.
  • Missing ordering physician.
  • Missing payer, insurance ID, or insured info (gender, DOB, relationship to insured).
  • Charge missing CPT code.
  • Charges with a 0.00 price.
  • Patient missing mailing address.
• The LIS will not generate invoices if required information is missing.
• Exception: If a price rule intentionally sets a charge to 0.00, the LIS marks it as Waived and allows invoicing.
• Use Rejection Report to identify missing information. To adjust payer‑specific requirements, see Master files > Payer > Required info.

Second grid – charge-level actions (More Options)

• Waive Charge Fees: Mark selected charges as waived.
• Cancel Waive: Revert waived status.
• Add Price Rule: Create a price rule for the selected charge.
• Update Ordering Physician.
• Edit Charge: Adjust details; the system routes you to the appropriate form based on charge type.
• View Applied Billing Rule: See which rule(s) set current pricing and charge generation.

Best practices

• Validate price lists and billing rules before batch runs.
• Use grouping (e.g., by Client, Patient, tests, gender) to review consistency.
• Run Rejection Report and fix issues, then click Recalculate to confirm clean results.
• Reserve Manual Mode for exceptions and document with Internal Comments.

Troubleshooting

• Orders not appearing: Check billable status, date range, patient filters, and billing holds.
• Invoice blocked by pricing: Add missing price rules or use Waive where policy allows, then Recalculate.
• Unexpected pricing: View Applied Billing Rule; adjust rule precedence or order data and Recalculate.

Tip: For smooth insurance billing, establish QA checks, train accessioners, run eligibility, correct data before billing, coordinate with clients to reduce missing info, and periodically review billing rules for payer updates.