Claims Setup: Splitting Claims When Adding to a Batch

• The target batch must be in CREATED status. Confirmed or submitted batches are locked.
• Service events must exist within your selected date range and pass basic validation (signed, no overlapping sessions, valid prior authorization).
• Events with warnings (e.g., provisional authorization) can still be included but should be resolved before submitting the batch to the clearinghouse.

The Claims Setup modal appears automatically at Step 6 of the Add Claim workflow. To get there:

1. Go to Billing > Batch Claims in the left sidebar.
2. Click the batch you want to add claims to. It must be in CREATED status.
3. Click the green + Add Claim button.
4. Set your date range and any optional filters, then click Submit.
5. Review the matched events and click Continue.
6. The Claims Setup modal opens, then configure the five options described below, then click Continue.

Each option answers one question: should events that differ in this way be placed on separate claims? The modal presents each option as a Yes / No dropdown.

1. Split by Provider

When set to Yes, Office Puzzle creates a separate claim for each unique rendering provider found in the selected events.

Insurance payers validate the provider NPI on every claim. Mixing service lines from two different providers on one claim can result in the second provider's services being paid at the wrong rate or denied outright.

2. Split by Billing Code

When set to Yes, events with different billing (procedure) codes are placed on separate claims.

While claims routinely carry multiple procedure codes as separate line items, certain payer rules restrict which codes can appear together. For example, mixing therapy CPT codes (e.g., 90837) and community-based HCPCS H-codes (e.g., H2014) on one claim can trigger bundling rules that result in one code being denied.

3. Split by Credential

When set to Yes, events rendered by providers with different license or credential types (e.g., BCBA, LCSW, RBT) are placed on separate claims.

Payers determine reimbursement rates based on the credential of the rendering provider. The same billing code can have different allowed amounts — or be non-covered — depending on who performed the service.

4. Split by Place of Service

When set to Yes, events delivered in different physical settings (e.g., office vs. client's home vs. telehealth) are placed on separate claims.

The Place of Service (POS) code on a claim directly determines which fee schedule the payer applies. Mixing service lines from different settings on one claim means the payer may apply a single fee schedule to all lines — which can result in underpayment or denial.

5. Match Claim POS with Line Items

When set to Yes, Office Puzzle automatically sets the claim header's Place of Service to match the service lines it contains, rather than using a default value.

In the electronic claim format (837P), Place of Service is reported in two places: the claim header and each individual service line. When these values don't match, some payers flag the claim as an error or apply the wrong fee schedule.

Expected Outcome

After clicking Continue in the Claims Setup modal:

• Office Puzzle runs the Create Claims background task. You can monitor progress in the Tasks Manager.
• The Select Claims modal opens showing a summary of all generated claims — total amount, claim count, line count, and per-claim details.
• Review the list and click Add (N) to add claims to the batch, or Cancel to go back and change your settings.

A green "Created successfully" notification confirms the claims were added. The batch detail page refreshes with updated totals. 

 Troubleshooting