Cycle Billing > Cycle Billing Claim Generation Criteria

The Cycle Billing claim generation program runs automatically each day through CRON. During each cycle, the program evaluates claims against the following criteria to determine whether a claim is eligible for generation:

•Auto Gen I/P and Auto Gen O/P (Insurance Companies Table, Page 1): These fields should be left blank or set to N. Although the Cycle Billing program ignores these fields during claim generation, TruBridge recommends disabling Autogen for Financial Classes that utilize Cycle Billing.

•Medical Records Complete (Insurance Companies Table, Page 1): This field may be set to Y or N.

▪Y - The Medical Records Grouper screen must contain a Finish Date greater than the last Billed Date for each billing cycle.

▪N - The Grouper Finish Date is not considered during Cycle Billing claim generation.

•Lag Days (Insurance Companies Table, Page 1): Specifies the number of Charge Days that must be closed after the patient's Next Cycle End Date before a claim is eligible for generation.

▪For example, if the Next Cycle End Date is 06/11/25 and Lag Days is set to 3, Charge Days must be closed through 06/14/25 before the account meets the Lag Days requirement. The Charges Closed Thru Date may be viewed through Business Office Functions.

•Coverage Dates (Pay Source Table): A Coverage From Date must be present and a Coverage To Date must not be present for the claim to be eligible for Cycle Billing generation. If the Coverage From Date is a future date, the claim will not generate, as future dates are typically used to accommodate insurance coverage changes that will take effect at a later date.

•Next Cycle End Date (Pay Source Table): The Next Cycle End Date must be prior to the current date.

•Discharged Accounts: If a patient has a Discharge Date prior to the current date and an active Pay Source Table entry remains without a Coverage To Date, a claim is still eligible for generation.

NOTE: The Cycle Billing claim generation program evaluates the primary insurance claim when determining claim eligibility. If secondary and tertiary Pay Source entries exist, those claims generate when the primary claim meets all generation criteria. If no primary insurance claim exists, secondary and tertiary claims will not generate.

When all Cycle Billing criteria have been met, TruBridge EHR performs the following actions:

•Moves the claim from Approved status to Ready to Bill status.

•Creates the next Pay Source Table entry

•Sets the new Coverage From Date to the current date plus one day.

•Updates the Next Cycle End Date to reflect the ending date of the next billing cycle.