To create two separate claims for the same payer on an account, which feature should you use?

To create two separate claims for the same payer on an account, which feature should you use?

• A. Duplicate payer setup
• B. Group billing
• C. Claim split
• D. Separate claims by payer

Answer: (C)

Claim split is used to divide the charges from one encounter into multiple claim records that still go to the same insurer. This is needed when different parts of the visit must be billed under separate billing rules, service types, or line items, yet you want both claims submitted to the same payer so the payments appear on the same remittance. Group billing would combine items into a single claim, and separating by payer would create claims for different payers, not two claims to the same one. So the feature you need is claim split.

Claim split is used to divide the charges from one encounter into multiple claim records that still go to the same insurer. This is needed when different parts of the visit must be billed under separate billing rules, service types, or line items, yet you want both claims submitted to the same payer so the payments appear on the same remittance. Group billing would combine items into a single claim, and separating by payer would create claims for different payers, not two claims to the same one. So the feature you need is claim split.