ServiceXG Basics

Add, update, and delete claims calculations

The Claims Calc Details workspaces contains a calculation detail table with and corresponding data fields. If you need to override any system-generated information, select the row to update and use the entry fields below the table.

Access the Claims Calc Detail workspace

Home > Administration Processes > Claims Processing or Claims Entry.

Add claims calculations

1. From Claims Processing, click the Calc Detail workspace tab.

   

   Any field with an asterisk * next to it or a red border around it must be completed before you can continue.

2. Click .
3. Select a claim Pay Type Identifies the processing method. (B - Basic, BR# - Basic Reversion, M - Major Medical, and MR# - Major Medical Reversion). from the list.
4. Enter the allowable amount The lesser of the considered amount and the pricing amount (UCR, fee schedule, etc.) amount.
5. In CI%, enter the benefit percentage that is the claimant's responsibility after the deductible The deductible is an initial dollar amount which is the member's contractual responsibility, usually on a calendar year basis. The plan will exclude this amount from the charge before determining payment. amounts are met.
6. Complete the remaining information as necessary.
7. Click to show the updated totals.

   • You might receive an information message letting you know the line item won't automatically recalculate. You should verify the claim messages and the liability amounts. The line item isn't recalculated because you would lose your changes.

• If the COB A provision for determining benefits when a member has more than one benefit plan. is greater than the Covered amount, a warning message displays: COB is greater than covered.
8. Press F7 or to validate and calculate the claim.

Update claims calculations

1. Click anywhere in the row containing the calculation to update.
2. Change the necessary information.
3. Click to display the updated information in the table.
4. Press F7 to validate and calculate your entries.
5. Click if you're finished updating information.

Delete claims calculations

1. Click anywhere in the row containing the calculation to delete.
2. Click to delete.
3. Press F7 to validate and calculate your entries.
4. Click if you're finished updating information.
   • You might receive edits when you use F7 or Save.

SEE ALSO