Cycle Billing > Exceptions List

If a claim cannot be generated or the Next Cycle End Date cannot be calculated, the account is added to the Cycle Billing Exceptions List for review. Accounts on the Exceptions List should be reviewed daily to ensure Cycle Billing claims continue to generate as expected. To access the Cycle Billing Exceptions List, select Web Client > System Menu > Master Selection > Insurance > Go to Cycle Billing Exceptions.

A search feature is available to locate exceptions by:

•Account Number

•Admit Date

•Patient Name

•Reason

•Service Code

•Stay Type

•Sub Type

When searching by Reason, a drop-down list is available to select a specific exception type.

Exception Reasons

The following exception reasons may cause an account to appear on the Exceptions List:

•Unable to generate claim due to invalid Cycle Billing table setup: Occurs when the Stay Type, Sub Type, Service Code, or Financial Class on the account no longer matches the configuration established in the Cycle Billing Table. This typically occurs when account information or Cycle Billing Table settings are modified after the Pay Source entry has been created.

•Unable to update Next Cycle End Date due to lack of current precert dates: Occurs when required Pre-Certification dates are missing or when the Pre-Certification To Date is less than or equal to the calculated Next Cycle End Date. For example, if the Pre-Certification To Date is 06/10/25 and the Next Cycle End Date is 06/13/25, claim generation does not occur because the certification period has expired.

•Lab multi-channel overflow: This exception is not currently used.

•Unable to generate claim due to missing Next Cycle End Date: Occurs when a Next Cycle End Date was not calculated or manually entered in the Pay Source Table. This commonly occurs when a Pay Source entry is created but the screen is exited before the Next Cycle End Date is established.

•Unable to generate claim due to missing MR Finish Date: Occurs when MR Complete is enabled on Insurance Companies Table, Page 1 and the account either does not contain a Medical Records Finish Date or the Finish Date is not greater than the last billed date on the account. For example, if the last claim was billed on 06/13/25 and the Medical Records Finish Date is 05/29/25, claim generation does not occur because the Medical Records information has not been updated since the previous billing cycle.

•Unable to generate claim due to invalid Financial Class: Occurs when the Financial Class associated with the claim no longer exists in the Insurance Companies Table.

•Unable to generate claim, no primary insurance in Pay Source: Occurs when no Pay Source entry exists with a Primary Switch of Y. The Cycle Billing claim generation program evaluates the primary insurance claim when determining claim eligibility. Secondary and tertiary claims generate only when the primary claim meets generation requirements.

The following options are available on the action bar:

•PDF: Displays the Exceptions List in PDF report format.

•Refresh: Updates the information displayed on the Exceptions List.

•Back Arrow: Returns to the Insurance System - Claim Indices screen.

Additional Exception Fields

The Pay Source Table may be accessed directly from the Exceptions List by selecting an account. To access the Pay Source Table from the Exceptions List, select Web Client > System Menu > Master Selection > Insurance > Go to Cycle Billing Exceptions > Select an Account.

The following additional fields are available for accounts on the Exceptions List:

•Exception Description: Displays the reason the account was added to the Exceptions List.

•Remove Exception: Removes the account from the Exceptions List after the underlying issue has been corrected. If the exception is resolved but Remove Exception is not selected, the account remains on the Exceptions List until the Cycle Billing claim generation program runs again.

NOTE: After selecting Remove Exception, select Save to retain the change.