Problem Statement

Charges held by edits sit unbilled until staff manually resolve the flagged issue. When an E&M charge carries a Place of Service that doesn't match the visit's patient class, it holds because payers price by site of service, and a biller must determine whether the POS or the CPT is wrong before it can go out. 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 reviews E&M charges with Place of Service (POS) mismatch edits and updates either the POS or CPT based on the visit's patient class to clear the edit.