Claims Validation Rejection

Description:

This report shows all claims validation requests that were returned unsuccessfully by the Sandata’s Claims Validation system. The report shows the request including the error message returned.

Use:

Use this report to quickly identify claims where matching EVV information was not found. This can assist in identifying visits that require action so they can be resubmitted to the claims validation system.

Fields and Columns:

Parameters

Use the following fields to limit the report output to:

Field	Description
Payer	visits for the selected payer(s)
Program	visits for the selected program(s)
Service	visits for the selected service(s)

Report Grouping

Reports are grouped by the following fields. Each change in these fields results in a page break.

Field	Description
Account	the provider agency’s Sandata EVV account number
Provider	the state assigned identifier for the prover (e.g Provider Medicaid ID)

Report Output

Each column of the report lists:

Columns	Description
Received	the date the claim was received by Sandata Claims Validation
Batch ID	the batch ID number for the claims validation request
Trans ID	the transaction ID number for the claims validation request
Invoice Control NO	the invoice control number for the claims validation request
Line NO	the line number within the invoice
Client ID	the Sandata client ID
Visit Range	the date range for the claim where the vists were reviewed
Payer	the payer for the claim line
Program	the program for the claim line
Service	the service for the claim line
Bill Unit	the billable units for the claim line. This reflects the total billing requested for the date range
Exeption	the information returned for the failed claims request
Provider Medicaid ID	the client's Medicaid ID and/or Alternate Medicaid ID If not available, Payer ID. If newborn support is enabled and the client is flagged as a newborn, is shown as "N".
Client Name	the client's name. Blank if unknown.
Units Found	the total bilable units for all visits found matching the request criteria
Visits	the number of visits found which were reviewed for the claims request

Sample Report

Claims Validation Rejection - Sample