Claims — Types, Creation & Management
Claim Types
Type | Form | Use Case |
Professional | CMS-1500 | Outpatient, IOP, and therapy services |
Institutional | UB-04 | Residential, PHP, detox, and higher levels of care |
CMS-1500 and UB-04 claims can be converted between formats. Data loss is possible when converting — review the system warning carefully before proceeding. This conversion is not easily reversible.
Creating Claims
There are three ways to create claims:
Single: Use the Actions menu on a service or encounter.
Bulk: Select multiple services and choose Create Claim.
Autogenerate: Configure automatic claim creation in Billing Configuration on a set schedule.
Before a claim can be created, the encounter must have matched a service rule with a CPT code, and all required fields (including federal tax ID) must be populated on the relevant facility record.
Claim Attachments
Some payers require supporting documentation with a claim — for example, court orders, treatment plans, or for secondary claims, the primary EOB. Add attachments via the Attachments tab before submitting.
How Services Are Split Across Claims
Services will be placed on separate claims when:
They have different authorization numbers, or one has an authorization and one doesn't
The "Force to separate claims" toggle is enabled on the service rule
A calendar month claim split is configured
There is only one authorization field per claim. All service lines on a claim must reference the same authorization.
Claim Notes
Box 19 (CMS-1500) and Box 80 (UB-04) are internal remarks fields and are not transmitted to payers under normal circumstances. The allowed rate is also not transmitted. The exception is the 42 CFR Part 2 NTE requirement for certain Minnesota payers — see the MN-Specific Rules article.
Claim Line Limits
Claims with more than 50 service lines will fail at the invoice level. If you have a claim with more than 50 lines, split it into multiple claims before invoicing.
Claim PDFs
CMS-1500 PDFs can be downloaded via the Stedi portal: go to the claim's Overview tab and select "Download CMS 1500 claim PDF." UB-04 PDF export is not currently supported in Ritten.