Problem Statement

Charges held by edits sit unbilled until staff manually resolve the flagged issue. When a diagnosis code is incorrectly linked in the primary position on an E&M charge, the edit holds it because the primary diagnosis drives medical necessity; a biller has to reorder the diagnoses so an appropriate code sits primary, or route the charge to coding when no other diagnosis is available. While these accounts wait, they accumulate in Discharged Not Final Billed (DNFB), lengthening time-to-cash and risking revenue leakage on services that were performed but never cleanly billed.

Automation Solution

This automation reorders diagnoses on E&M charges when specific diagnosis codes are incorrectly linked in the primary position and resubmits, or routes to coding when no other diagnosis is present.