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.
Related Topic
Updated 8 months ago