ServiceXG Basics

Add, update, or delete claims messages

The claims messages show on the Explanation Of Benefits (EOB) or can show as internal comments (won't display for the member) while processing a claim.

To access the Messages workspace:

1. From the Administration Processes menu, select the Claims Processing or Claims Entry area, then double-click the appropriate Claims Processing or Claims Entry function.

2. From the Claims screen click the Messages workspace.

   

   Claims Messages workspace table field descriptions

   Column	Description
   Level	Claim message level Claim—Indicates the message applies at the claim level. Line—Indicates the message applies to a particular claim line.
   Line	Line number The claim line number associated to messages at the line level.
   Template	A pre-formatted user-defined message. The format is <Template Code>—<Type Code>—<Type Description>.
   Recipient	Message receiver M—Member P—Provider (default) MP—Member and Provider Blank—Internal comment
   Message	The internal or other message that will display for the recipient.

Add claims messages

1. From the Claim Entry or Processing screen, click the Messages tab.

   

2. Click to enable entry.
3. Select the line number from the Line list or leave it blank to choose claim instead.
4. Choose from the following options:
   • Don't use a template and type the text to display in the Message box. Skip to step 5, below.

   OR

   • Select the Template to see the corresponding Message and Variables.

     EXAMPLE

     If you select 9—M—Maximum, ${3} REMAINING OF YOUR ${1} LIFETIME MAJOR MEDICAL MAXIMUM ACCORDING TO THE SCHEDULE OF BENEFITS displays in the Message box. ${1}${2} and ${3} show below the Messages box as Variables definitions.

     Hint: To display additional variable definitions, point to the messages icon following the Variables definition.

     1. In the Variables box (next to Recipient), type the values to replace each Variable in the message. Separate each value with a semi-colon (e.g. 200;2000). If there are no values, the message variables are taken from the claim data.

        EXAMPLE

        A value for variable ${3} = Diff in Sched and Accumulated Amnts might be 200 and for variable ${1} = Schedule Defined Maximum Amount might be 2000.

        

5. Choose who will see the message from the Recipient list (M-Member, P-Provider or MP-Member and Provider). Leave the recipient blank to make this an internal comment.
6. Click and the message information shows in the Messages table.

7. If you're finished updating the claim, click to validate and calculate the claim.

Update claims messages

1. Click anywhere in the row containing the message that you want to update.
2. Change the necessary information.
3. Click and the message information shows in the Messages table.
4. If you're finished updating the claim, click to validate and calculate the claim.

Delete claims messages

1. Click anywhere in the row containing the message to delete.
2. Click .
3. Click and the message no longer shows in the Messages table.
4. If you're finished updating the claim, click to validate and calculate the claim.

Filter auto-adjudication messages

Select the Filter out... checkbox above the Messages table to filter all messages generated by the auto-adjudication.

SEE ALSO