ServiceXG Basics

Reverse a released claim with a printed uncashed check

If a claim check has already been printed, you must adjust the claim through the check. First, void the check/register before reissuing the claim.

Use the following instructions when a claim is in R—Released status, the check process has run, the check wasn't mailed and the claim shouldn't have been entered (e.g. entered in error, etc.).

Go to: Home > Administration Processes> Claims Adjustments > Claim Reversal/Void

1. Enter the Draft and Check#. You must use a draft and check number to void a check.

   Hint: To find the claim information, see the Claim Payment tab (see Find claim payment information).
   • After entering the draft and check number, the remaining fields update and the cursor moves to the Reissue field.
   • Void Reg (Register) is automatically set to Y, since the check is printed and you have the uncashed check.
2. Enter N (No reissue) in Reissue. You don't want to reissue the claim since it shouldn't have been entered.
   • Since Reissue is N, no claims are reissued and a claim entry session doesn’t display.

3. Enter an adjustment Reason Code that will show in the Adjustment viewport (see Adjustments viewport field descriptions).

   A code that identifies the adjustment reason. These codes can be site specific.

   • AD—admission choice error
   • BA—billed amount error
   • BC—benefit code error
   • BP—billing provider choice error
   • BQ—billed quantity error
   • CB—COB/prepaid entry error
   • CD—check damaged
   • CL—claimant choice error
   • D—diagnosis error
   • DC—disputed case choice error
   • DP—duplicate claim
   • DS—dates of service error
   • IL—illness choice error
   • PA—provider address error
   • PO—payment override error
   • PP—PPO choice/pre-priced entry error
   • PR—procedure error
   • RD—received date error
   • RF—referral choice error
   • RS—referral service choice error

4. Enter C to continue. The original claim refno displays at the bottom of the screen.

   Hint: Take note of the refnos that display for any necessary additional processing.
5. Press Enter and the reversed refno displays. The claim reverses and any informational or error messages display.
   • All accumulators are automatically calculated and adjusted.

   • Any informational or error messages display.

6. Press Enter again to close the screen.

   Important! If you accidentally void a released claim, void it again or reverse it: enter the adjusted reference # (ex. A00029 in the example below) in Reverse/Void. Void the reversed claim in the same accounting month and return the first claim to its original status or void the claim again if you're in a new accounting month.

Examples are given for illustration. Other errors can cause the same adjustments.

Void and reissued claim example

	Reference #	Paid	Status
Entered	A00028	$240.00	P—Paid
Adjusted	A00028	$240.00	AP—Adjusted Paid
	A00029	-$240.00	A—Adjusted

Adjust a released claim with a payment issue

Use the following instructions when a claim is in R—Released status, the check process has run, the check wasn't mailed and there is an over or underpayment.

1. Enter the Draft and Check#. You must use a draft and check number to void a check.
   • The remaining fields update and the cursor moves to the Reissue field.
   • Void Reg (Register) is set to Y, since the check is printed and you have the uncashed check.

2. Enter M—Manual in Reissue to enter the claim correctly.

   Note: You can't manually reissue checks that have multiple claims' payments. Either void the check and reprocess each claim, or automatically reissue all claims and reverse the reissued incorrect claim and then manually reissue that claim.
3. Enter an adjustment Reason Code. The reason code will show in the Adjustment viewport (see Adjustments viewport field descriptions).

4. Enter C to continue. The original claim refno displays at the bottom of the screen.

   Hint: Take note of the refnos that display for any necessary additional processing.

5. Press Enter and the reversed refno displays. The claim reverses and any informational or error messages display.

6. Press Enter again and the new claim refno displays at the bottom of the screen. Any informational or error messages display. All accumulators are calculated and automatically adjusted.

7. Press Enter again to open the new claim.

   Important! If you accidentally reverse and reissue a claim, reverse the reissued claim and manually reissue another claim. Don’t void or reverse the original reversal (e.g. A00029 in the example below) because a duplicate payment will be created.

8. Correct the claim and save it. The claim will be in R—released status.

Examples are given for illustration. Other claim errors can require the same adjustments.

Adjusted underpaid claim example

	Reference #	Paid	Status
Entered	A00028	$240.00	P—Paid
Adjusted	A00028	$240.00	AP—Adjusted Paid
	A00029	-$240.00	A—Adjusted
	A00030	$300.00	R—Released

 

Adjusted overpaid claim example

	Reference #	Paid	Status
Entered	A00028	$240.00	P—Paid
Adjusted	A00028	$240.00	AP—Adjusted Paid
	A00029	-$240.00	A—Adjusted
	A00030	$200.00	R—Released

 

Adjusted unpaid claim example

	Reference #	Paid	Status
Entered	A00028	$240.00	P—Paid
Adjusted	A00028	$240.00	AP—Adjusted Paid
	A00029	-$240.00	A—Adjusted
	A00030	$240.00	R—Released

SEE ALSO