Claims Rejected or Denied Workflow
If a claim is rejected by the payer, make the requested changes and generate a new submission with a new patientControlNumber. The patientControlNumber would be the main value used in tracking specific submissions.
If a claim is denied by the payer, a corrected claim would be required. The claim frequency code should be submitted as a '7' and the payer claim control number must be included on the claim in the claimControlNumber field in the claimSupplementalInformation. The claimControlNumber is the number assigned by the payer to identify a claim. The patientControlNumber should be sent as a unique value. Once submitted, the payer will review the claim and make any changes based on their internal review.
To include additional documents, use the Attachment Submission API.
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Updated 7 months ago