Configuration Quick Reference
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This page is a meeting cheat sheet for billing managers. It lists the configuration choices your facility can make, the shipped default for each choice, and the review alert each choice produces. Use it to prepare an onboarding or tuning discussion.
You do not edit these settings yourself. Your facility configuration controls every item on this page. Contact your Hank representative to change a value. For the full explanation of each area, read the Facility Configuration Guide.
| Choice | Default |
|---|---|
| Add a review alert to every claim | Off. When on, every claim gets the HARDSTOP alert forced_review_facility_setting at severity 10. |
| Anesthesia practice type | Standard Direction |
Practice type archetypes:
| Choice | Options | Default |
|---|---|---|
| Medical direction | On, Off | On |
| Time allocation | Both full time, actual time, primary only | Both full time |
| Action when all TEFRA criteria are met | Normal billing, bill the physician with no modifiers | Normal billing |
| Action when TEFRA criteria are not met | Continue and raise an alert, drop to CRNA, drop to CRNA without the alert, drop to supervision (AD), keep the physician and raise a HARDSTOP alert | Continue and raise an alert |
| Separate action for AA-only cases | Same as above, or a different action | Same as above |
| Alert type and severity when TEFRA is not met | HARDSTOP, COMPLIANCE, FINANCIAL, INFORMATIONAL | COMPLIANCE, severity 8 |
| Attestation strictness | Strict, moderate, lenient | Moderate |
| Maximum concurrent directed cases | 1 to 4 | 4 |
| Action when the concurrency limit is exceeded | Drop to supervision (AD), raise a HARDSTOP alert | Drop to supervision |
The autocoder checks seven TEFRA requirements. Each requirement is enforced by default:
Billing scenarios also carry defaults. A physician directing a CRNA bills both providers with QK and QX. A physician with a resident bills the physician with the teaching modifier. A CRNA alone bills QZ. An AA alone raises a HARDSTOP alert.
| Scenario | Rule id | Default outcome | Alert |
|---|---|---|---|
| Ultrasound 76937 or 76942, storage not documented | ultrasound_76937_no_storage_documented, ultrasound_76942_no_storage_documented | Billed | COMPLIANCE, severity 7 |
| Ultrasound 76937 or 76942, documented as not stored | ultrasound_76937_explicitly_not_stored, ultrasound_76942_explicitly_not_stored | Not billed | FINANCIAL, severity 9 |
| TEE found only in the case event times | tee_from_events_only | Billed | COMPLIANCE, severity 5 |
| Procedures from a lines, drains, and airways note | lda_procedures | Not billed | INFORMATIONAL, severity 1 |
| Central line used as the introducer for a Swan-Ganz | same_stick_central_access | Bundled | none |
| The same procedure documented more than once | duplicate_procedures | Billed once | INFORMATIONAL, severity 2 |
| Failed or aborted procedure | failed_procedures | Not billed | INFORMATIONAL, severity 4 |
| Items bundled by NCCI edits | claimcleaner_bundles | Removed | INFORMATIONAL, severity 3 |
| Nerve block billed inside anesthesia time | nerve_block_billed_as_time | Alert only | FINANCIAL, severity 5 |
| Neuraxial procedure without documented times | neuraxial_without_times | Alert only | INFORMATIONAL, severity 4 |
| Obstetric case | ob_case_review | Alert on every case | HARDSTOP, severity 2 |
| Cosmetic procedure that needs split billing | cosmetic_procedure_split_billing | Alert | HARDSTOP, severity 10 |
| No anesthesia CPT code on the claim | anes_no_cpt_code | Alert | HARDSTOP, severity 10 |
| Times taken from a source other than the case event times | anes_non_case_times_source | Alert | FINANCIAL, severity 3 |
| Date of service over one year old | anes_dos_age_warning | Alert | HARDSTOP, severity 10 |
| CPT code on the mandatory review list, currently 01999 | required_code_review | Alert | FINANCIAL, severity 8 |
| ASA physical status read from a handwritten note only | handwritten_asa_source | Alert | HARDSTOP, severity 6 |
| More diagnosis codes on a line than the limit | max_icd_per_line_item | Extra codes dropped, limit 4 | INFORMATIONAL, severity 1 |
Two more defaults sit in the same block. The preferred NCCI modifier is 59. Nerve block lines carry the G89 pain diagnosis only.
The autocoder adds 99100 for the age qualifier and 99140 for the emergency qualifier when the record supports them. On Medicare-primary claims the shipped default moves 99100, 99116, 99135, and 99140 out of the billable lines and records them for documentation. An INFORMATIONAL alert reports the move. Your facility configuration can turn the suppression off through qualifyingCircumstances.suppressForMedicare. Ask for this choice before your first production run, because the suppression is quiet apart from the low-severity alert.
The autocoder scores its confidence in each code. A code below the threshold gets a review alert.
| Code type | Default threshold |
|---|---|
| Anesthesia codes (00100-01999) | 85 percent |
| Surgical codes | 80 percent |
| Diagnosis codes | 80 percent |
| Modifiers | 80 percent |
Every alert carries a severity from 1 to 10. Severity states review priority only. The alert type states what kind of problem the autocoder found.
| Check | Default |
|---|---|
Low confidence alerts (lowConfidenceChecks) | On |
Anesthesia time validation (timeValidationChecks) | On |
Required note checks (requiredNoteChecks) | On |
Require a provider NPI (npiRequired) | Off |
Primary anesthesia line present (primaryAnesLineItem) | On, HARDSTOP severity 10 |
Primary diagnosis attested (primaryIcdAttested) | On, HARDSTOP severity 7 |
Physical status supported by the record (physicalStatusSupported) | On, FINANCIAL severity 5 |
Your facility configuration can also downgrade named alerts. A downgraded alert becomes INFORMATIONAL. It is not removed from the claim. Give your Hank representative the exact alert ids, because a broad pattern can downgrade an alert you want to keep.
Required note types start empty. Add the note types your facility guarantees, for example Pre-Op, Intra-Op, Post-Op, staff times, case events, or the surgeon note.
| Required field | Default | Alert if still missing |
|---|---|---|
| Patient name, first and last | Required | HARDSTOP, severity 8 |
| Patient date of birth | Required | HARDSTOP, severity 8 |
| Patient MRN | Required | FINANCIAL, severity 6 |
| Insurance information | Required | HARDSTOP, severity 7 |
| Date of service | Required | HARDSTOP, severity 10 |
| At least one line item | Required | HARDSTOP, severity 10 |
| Surgeon name | Required | HARDSTOP, severity 8 |
| Provider name on each line | Required | HARDSTOP, severity 8 |
| Provider role on each line | Required | HARDSTOP, severity 6 |
| Provider title on each line | Required | HARDSTOP, severity 5 |
| Provider NPI on each line | Not required | none |
| Surgeon NPI | Not required | none |
The autocoder first tries to recover a missing patient name, date of birth, MRN, insurance, date of service, or surgeon name from the record. The alert fires only when the field is still missing.
Give a roster for each provider group you bill: physicians, CRNAs and AAs, and surgeons or referring providers. A provider who is not in the roster gets a blank NPI field on the claim.
| Choice | Default |
|---|---|
Add ASA physical status modifiers automatically (asa_p_modifier_control) | On |
Discontinuous time handling (discontinuous_times) | Combine the gap into the first segment |
Handwritten page sensitivity (handwrittenRatioCutoff) | 2 percent of the packet |
| Maximum diagnosis codes per line | 4 |
An acute pain service round is a visit on a day after surgery. Facilities usually send the comprehensive record, which also holds the surgery documentation. The autocoder detects the round from the note types and the wording. It then codes the round, not the surgery.
| Choice | Default | Notes |
|---|---|---|
Detect and code pain rounds (postOpPainRounds.enabled) | On | Outcomes are 01996 for a managed epidural or subarachnoid catheter, a subsequent care visit code 99231-99233 for a peripheral nerve catheter or a single-dose neuraxial opioid, or nothing billable when the record supports no separate service. Turn the lane off only with care. With the lane off, a round packet codes the already billed surgery again. |
Review gate on pain-round claims (postOpPainRounds.reviewGate) | Off | When on, in-scope claims get the HARDSTOP alert postop_pain_rounds_review_gate. Severity is 1 to 10 and defaults to 7. Scope coded covers claims the rounds lane coded. Scope detected also covers normally coded claims from a packet with round content. |
| Mixed pain-round signals | Always alerted | The autocoder codes normally and adds the HARDSTOP alert postop_pain_round_ambiguous. This alert is not configurable. |
These choices apply to facilities on the E/M specialty: office and outpatient visits 99202-99215, hospital inpatient and observation visits 99221-99239, and emergency department visits 99281-99285. A deterministic engine assigns the visit level from the documented decision making and the total time.
| Choice | Default | Notes |
|---|---|---|
Qualifying encounter note required (qualifyingEncounterNotes) | Refuse when absent | The shipped qualifying types are the office visit note, the history and physical note, the progress note, and the emergency medicine summary. A packet with none of these gets the HARDSTOP alert eandm_qualifying_note_refusal and no codes. A facility override replaces the whole list. |
Modifier 25 posture (emPolicy.mod25Aggressiveness) | Conservative | Conservative never adds modifier 25 by itself. Standard adds it on same-day procedures. Either posture raises the alert eandm_mod25_same_day_procedure on a same-day visit plus procedure. |
| Incident-to election, preventive split posture, G2211 policy, payer ruleset map | Off or conservative | Reserved for a later release. A non-default value raises the alert eandm_policy_election_not_implemented and does not change billing yet. |
| Choice | Default | Notes |
|---|---|---|
Code interventional radiology procedures (irCoding.enabled) | On | The autocoder codes procedure-flavored packets as interventional radiology. Incomplete interventional documentation raises review alerts. With the choice off, interventional charts return to your coders instead. Diagnostic reads are the same either way. |
| Type | What it means |
|---|---|
| HARDSTOP | Something is missing or conflicting that would cause a payer rejection or denial. |
| COMPLIANCE | A regulatory or compliance concern. |
| FINANCIAL | A possible revenue impact: a missed charge, or a charge the record may not support. |
| INFORMATIONAL | Something noteworthy. No action is required. |
| OTHER | An internal system event, for example an external service failure. |
| Setting | Standard Direction | Teaching Hospital | CRNA Independent | MD Only |
|---|---|---|---|---|
| Medical direction | On | On | On, non-directed | On |
| Physician plus CRNA | Both, QK and QX | Both, QK and QX | CRNA only, QZ | HARDSTOP alert |
| CRNA alone | QZ | HARDSTOP alert | QZ | HARDSTOP alert |
| Required notes | Pre-Op | Pre-Op, Intra-Op, Post-Op | None | None |
| Primary provider | Most time | Most time | Most time | Most time |
| All other settings | Base defaults | Base defaults | Base defaults | Base defaults |
What happens next depends on how your organization consumes HANK CODES. In HANK Claim Maker, a HARDSTOP alert places the claim in the review queue your administrators configured for it. Organizations that consume the coding API directly decide in their own workflow which alerts pause a claim, who reviews them, and when a claim is released.