--- id: billing-charge-master-and-zero-dollar-guard title: Charge Master and the $0.00 claim guard module: billing audience: [billing, admin] roles: [biller, admin] type: how-to estimated_minutes: 6 last_reviewed: 2026-08-31 app_route: /facility/{facility_uuid}/billing/charge-master related: - billing-overview - billing-work-queue - billing-submit-claim - billing-coding-review-drawer tags: [billing, charge-master, pricing, zero-dollar, 837P, Stedi, CPT, HCPCS] --- The Charge Master is where you set the price for every procedure your facility bills. Medipyxis will not let a claim leave the system for `$0.00` — not one line at $0, not a claim total at $0, no escape hatch. This page shows how to set prices, how the pre-flight guard reads them, and what the biller sees when a price is missing. ## Before you start - You have the `biller` or `admin` role. - Your facility is active and you know which CPT/HCPCS codes you bill. - If you use different rates for insurance vs. self-pay, you have both lists ready. --- ## Open the Charge Master Navigate to `/facility/{facility_uuid}/billing/charge-master`. The page opens with three tabs: | Tab | What it holds | |---|---| | **Insurance Charges** | The per-unit price used when a claim is priced against an insurance payer. | | **Self-Pay Charges** | The per-unit price used when the patient is self-pay. | | **Templates** | Superbill templates (fixed CPT/HCPCS/ICD-10 code lists) you attach to visit types. | Each rate is per-unit, per-code, per-facility. Add a code, set the amount, save. --- ## How pricing flows into a claim When a claim is drafted from a visit, `priceClaimLine` reads `facility_charge_master` for each procedure line: 1. It matches the row by facility + CPT/HCPCS + insurance vs. self-pay context. 2. It multiplies the per-unit rate by the units on the line. 3. It writes the resulting charge onto the 837P service line before submission. If a line has no row in the Charge Master, the price is `$0.00` — and the pre-flight guard rejects the whole claim. --- ## The $0.00 guard Two rules stop a `$0.00` claim from ever reaching a payer, and both are named requirements from April Alfaro (2026-08-27): **1. No line may have a `$0.00` charge.** Every service line on the 837P must carry a positive dollar amount. If any line is `$0.00`, submission is refused with a message that names the code: > Claim cannot be submitted — No price on file for CPT 97597 at At Home Wound Care, PLLC — add it in Charge Master. **2. The claim total must exceed `$0.00`.** Even if every line individually passes some future relaxation of rule 1, the aggregate total is asserted separately: > Claim total is $0.00 — nothing is being billed. Add charges in Charge Master. Both rules run **before** the claim reaches Stedi. Nothing at Stedi ever sees a $0 line. There is no "legitimate $0 line" escape hatch — a claim asking a payer for $0 is always a defect, and it is one this system exists to catch. This guard exists because on 2026-08-27, right before go-live, the biller-facing pricing path was reading the wrong dollar-amount key on the service line: the 837P builder wrote `charge_amount`, the reader looked for `lineItemChargeAmount`, and every claim went through with $0 lines. The whole prod set — 1,134 claims — priced at $0. The guard is now permanent, on both the electronic path AND the manual paths (Mark as Submitted, Fix & Resubmit, Send Fax). --- ## The rejection message, made readable Until 2026-08-27, the biller-facing rejection was mangled by the submit UI — the same message was printed twice, wrapped in JSON brackets, and titled "Stedi Submission Failed" even though the rejection was pre-flight (Stedi never saw it). It read: > Stedi Submission Failed — Claim is missing required field(s): No price on file for CPT 97597 at At Home Wound Care, PLLC — add it in Charge Master.: ["No price on file for CPT 97597 at At Home Wound Care, PLLC — add it in Charge Master."] That was wrong three ways: duplicated message body, wrong prefix ("missing required field(s)" sent billers hunting for a blank box instead of Charge Master), and wrong blame (a pre-flight rejection never reached Stedi). It now reads: > Claim Not Submitted — Claim cannot be submitted — No price on file for CPT 97597 at At Home Wound Care, PLLC — add it in Charge Master. Multiple missing codes are listed one per line, and the toast stays visible for 12 seconds because a multi-line list takes longer to read. --- ## Steps — add a missing price 1. From the rejection toast, note the CPT/HCPCS code. 2. Open **Charge Master** for the facility → **Insurance Charges** (or **Self-Pay Charges** if the patient is self-pay). 3. Click **Add code** → enter the CPT/HCPCS → enter the per-unit dollar amount → **Save**. 4. Return to the claim in **New Claim** or the **Coding Review** drawer. 5. Refresh the claim (or click **Save & Next** and come back). The price now hydrates onto the line, and the Expected Total is a real number. 6. Submit. --- ## Templates The **Templates** tab is not a pricing surface — it holds superbill templates: fixed lists of CPT/HCPCS/ICD-10 codes you attach to visit types so a clinician sees the right code menu on the wizard. Templates carry no dollar amounts; those still come from **Insurance Charges** and **Self-Pay Charges**. --- ## Result Every claim leaving the facility has a positive charge on every line and a positive total. Any missing price surfaces immediately, in the biller's words, on the exact line that lacks a rate. When a biller adds the price, the same claim goes through on the next attempt with no code changes needed. --- ## Troubleshooting | Symptom | Likely cause | What to do | |---|---|---| | "No price on file for CPT XXXXX" on every claim for a new facility | The facility was set up without a Charge Master. | Add rates in **Insurance Charges** and **Self-Pay Charges**. | | Rate is set but the claim still rejects with $0.00 | The rate exists in the wrong tab (self-pay vs. insurance) for this patient. | Confirm the patient's payment method on the claim; add the rate in the matching tab. | | Rate is set correctly but the line still shows $0.00 in the drawer | The claim was drafted before you added the rate. | Re-open the claim; the Expected Total re-hydrates from Charge Master on load. Or open **Edit in Full Form** and save once. | | Toast title says "Stedi Submission Failed" | You are on an older client build. | Refresh the page to pick up the corrected title ("Claim Not Submitted"). | | A biller wants to submit a legitimately $0 line (e.g. no-charge follow-up) | There is no escape hatch — by design. | Do not attempt to bypass the guard. Book the encounter as non-billable in the Work Queue instead, or contact the payer directly. |