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Get a diagnosis onto the claim: "Not on claim", "Needs you" and "Needs review"

3-min read · What the chips in the bottom bar mean, how to put a suggested diagnosis on today's claim, and what to do when Matic says it needs you.

Written by Bryce Blackwell

All coding tools live in the bottom bar of the Note tab. Every suggested code is visible there and is one click to add to the claim or remove. This article explains the three chips physicians ask about most.

Rule of thumb: Matic bills only what today's documentation supports. Anything it can't support appears as a suggestion, and nothing goes on the claim until you accept it.

"Not on claim"

An amber Not on claim chip on an Assessment & Plan entry means the diagnosis is in the note but not yet on the claim. The bottom bar shows the count, for example 2 not on claim.

  1. Click the chip, or the N not on claim count in the bottom bar.

  2. Read the reason. It tells you why Matic held the code: it was suggested from today's visit, the note's wording didn't match the evidence, or the source couldn't be verified.

  3. If you addressed the condition today, click Accept for today's claim. The chip turns normal, the count drops by one, and the code appears under the visit line's diagnoses.

If the popover says Replaced on the claim by … (for example E66.9 replaced by E66.01), there's nothing to do: Matic already billed the more specific code. If it says Withheld by the coding engine, the documentation doesn't support billing it; add the detail to the note and regenerate if you disagree.

Known issue: in some notes the accept click flashes and the chip stays amber. A fix is in testing; see Known issues. Until then, add the diagnosis in athena after sending.

"Needs you"

Needs you on the note bar means Matic has a question it can't answer from the visit: an unanswered coding question (for example a vaccine that may not have been given today) or an empty assessment/plan box.

  1. Click Needs you to jump to the first open item.

  2. Answer the question with the buttons shown (for example Not performed today), or type into the empty A/P box.

  3. Matic re-runs the coding for that item. If it offers Retry, click it once; if nothing changes after a minute, report it with the section name.

"Needs review"

Needs review flags a code Matic kept but isn't confident about, usually because the evidence sits in a different section than expected. Click it to open the evidence panel, which shows the chart quote, the justification and any compliance flags. Keep, change or remove the code from there.

Add a diagnosis Matic missed

  1. In the bottom bar, click Add diagnosis to note. This starts a new Assessment & Plan box and attaches the code to the visit line.

  2. Search for the code. Type part of the name or the code itself. To change a code later, click the code chip and choose Change ICD-10 code or Show other ICD-10 candidates.

  3. Write the assessment and plan in the new box so the claim is supported.

A billed line needs at least one diagnosis, and a line holds up to four; turn one off first if you're at the limit.

Modifier 25 and G2211 prompts

When a procedure and an E/M are on the same visit, Matic asks Yes, add modifier 25 or No, drop the E/M. For Medicare continuity visits it may offer G2211; it's dropped automatically if the A/P is embedded in the note (Settings › Advanced). Answer the prompt before you send; unanswered prompts show as Needs you.

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