Billing Resubmission
When an exported claim is rejected, it can be corrected and resubmit for proper processing.
Determining the Resubmission Process
The process needed to correct and resubmit claim varies depending on the reason for the rejection. The following processes can be used to fix and resubmit the claim:
| 1. | Rollback Resubmission Process: Use this method when there is a structural issue with the file resulting in the entire Claim File not being processed. |
| 2. | Set to 05-Billable Resubmission Process: Use this method when an entire claim has been denied due to missing or incorrect data. |
| 3. | Voiding Line Items: Use this method when any portion of the claim has been paid but changes must be made to the invoice or if the entire invoice is paid but a line item must be changed. |
| 4. | Late Charge Resubmission Process: Use this method when a claim with the same client, service and date as a previously exported claim must be exported. |
| Note: Only users with the appropriate security rights can perform billing resubmission. | ||||||
| Note: Claims can be voided using the payer’s standard void process.
Once a claim is exported, use one of the following to view the claim’s status:
Rejections result in a 999 rejection file. They represent issues with the data within the application that requires correction. Claim denials are available via payer portal or Explanation of benefits (EOB). For additional information regarding denied claims, please contact the payer. |
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