ServiceXG Basics

Reverse a released claim with no check

After a claim has been moved from an In Progress—IP or Pended—HP status to a Released—R status, the claim is included in a check run for payment processing (usually in the form of a check). The check run process updates the R claim status to paid—P.

Reverse, correct, and reissue the claim

Use the following instructions when a claim is in R—Released status, verify the claim hasn't been selected for a check run, no checks were printed, and the claim had a payment error.

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

1. Enter the claim’s Refno.
2. At Void Reg—Register enter N since there is no check.
3. Enter M—manual in Reissue to create a new claim to correct.
4. You’re prompted to enter the new received date for the new claim at the bottom of the screen.
5. Enter the date action is taken in Action Date or press Enter to use today’s date.

6. Enter the required adjustment Reason Code that will show on the adjustment viewport (see Adjustments viewport field descriptions). Type All to display a window with options to select from. Your operator ID automatically shows as the Entry Operator.

   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
7. Enter C to continue. The original claim refno displays at the bottom of the screen.
8. Press Enter and the reversed refno displays. The claim reverses and any informational or error messages display. Any accumulators are calculated and automatically adjusted.
9. Press Enter again and the new claim refno displays at the bottom of the screen.

10. Press Enter again to open the new claim.

    

11. Correct and save the claim and it will be in R—Released status.

    Important! If you reverse and reissue the claim accidentally, 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 get created.

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

Underpaid claim adjustment example

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

 

Overpaid claim adjustment example

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

 

No payment claim adjustment example

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

SEE ALSO