Claim Defaults contain fields that are automatically carried over to your newly created claims. They can be changed at any time to a new default setting; once changed, the defaults will only take effect for newly created claims. Some Claim Defaults like the POS and the TOS can be defaulted in different sections of the application. A predefined order of priority exists when the same default field is set in multiple locations.
Place of Service (POS)
Default Place of Service: The priority order of the POS claim default is as follows:
Appointment Types: A POS claim default set up within an appointment type and used on claims created from the scheduler will have the highest priority in the hierarchy.
Payer: A POS claim default set up within a Payer record will have second priority on claims (Primary Payer Only).
Facility: A POS claim default set up within a Facility record will have third priority on claims.
Practice: A POS claim default set up within a Practice Record will have fourth priority on claims.
A POS default set up on a procedure code will always take priority over any other POS defaults. If no default POS code is selected anywhere, it will automatically default to POS 11 on the claim.
Type of Service (TOS)
Default Type of Service: The priority order of the TOS claim default is as follows:
Appointment Types: A TOS claim default set up within an appointment type and used on claims crated from the scheduler will have the highest priority in the hierarchy.
Practice: A TOS claim default set up within a Practice Record will have second priority on claims.
A TOS default set up on a procedure code will always take priority over any other TOS defaults. If no default TOS code is selected, it will automatically default to TOS 1 on the claim.
Check Your Understanding:
When multiple POS and TOS defaults are set throughout the application, it will impact the code that populates on the claim.
For example, if a POS code of 20 (IUrgent Care Facility) is set as a default for the Practice and a POS of 11 (Office) is set as a default for a Payer. Then that Practice and Payer (Primary Payer) are used on a claim, the POS would display as follows:
If the same claim is created from the scheduler using an Appointment Type with a POS code of 10 (Telehealth) set as a default, The POS on the claim would display as follows:
