PPS and IO: Modifiers

This article applies to Valant IO and the Private Practice Suite

A modifier is a code that provides information to indicate that a service or procedure has been performed and altered by some specific circumstance, but has not changed in its definition or code. There are different ways to add modifiers to charges in Valant. 

Users can manually enter modifiers to charges that have already been created  by doing the following:

  1. Go to Billing|View/Edit Charges and select the patient (For add on codes users may need to temporarily un-bundle codes by unchecking the "Bundle Primary and Add on Codes" checkbox on the primary charge)
  2. Click the line item for the charge that needs to be modified
  3. On the details page select the line item for the code below
  4. Click View/Edit Detail
  5. Enter modifiers in the "Modifiers (1-4)" field (Users can put up to four modifiers per claim)
  6. Click Ok (If codes were unbundled be sure to rebundle the codes)
  7. Click Save

Users can add modifiers when they create charges in Valant by doing the following: 

  1. Click Billing|Create Charge
  2. Fill out the information or the charge and include modifier information in the "Modifiers (1-4)" fields

This method is used done when manually creating charges and bypassing putting an appointment on the scheduler.

To automatically apply insurance modifiers to claims users can set up a Fee Schedule for each insurance company. 

  1. Click Persons and Institutions|Insurance Companies and select the desired insurance company. 
  2. Click Options|Fee Schedules (if you do not see this options it could be a permissions issue or this module is not turned for your practice may need to contact Valant Support to turn on this feature ) 
  3. This will open the "Fee Schedules" dialogue box
  4. Click New Fee Schedule, create a name and click OK
  5. Then users can create a fee schedule and include modifiers to have them automatically appear on charges
  6. Click Save

Note: Modifiers set up through Fee Schedules only appear on primary codes. For modifiers to appear on add-on charges they need to be added manually. 

For more information on Fee Schedules please review this article. Please note that if you create or update a fee schedule it will not apply for existing charges or appointments that have already been created. The code will need to be updated on those appointments on the Scheduler. 

In order to find out which modifiers are required for claims it is recommended to look at payer specific submission policies. These can vary for every payor, but are usually available on their website or by contacting the payor directly.

Reivew how to add Modifiers to Patient Statements here.

 

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