ServiceXG Basics

Recall a released claim

To limit the number of pricing and error adjustments you have to make, you can recall a released claim, provided your system is configured to use this option, you have the security level to use this feature, no check has been processed for the claim, and the claim hasn’t been split.

You can recall individual claims from the Claim menu in Claim Information, or from Claims History. If you have several released claims you need to update, see Recall released claims from a list. Once a released claim is recalled, the claim data is returned to it’s previous state and the claim is available for processing and corrections.

Recall a released claim from Claim Information

1. Search for and open the released (R—status) claim to recall.

   Note: You cannot recall a claim unless you have the proper access and the claim has been released (R status), is on file, isn’t locked, hasn’t been split, and there hasn’t been a check processed for the claim.

2. Select Recall Released Claim from the Claim menu. If you don’t see this menu option, either the claim cannot be recalled or you don’t have the correct permissions to recall a claim.

   

3. A confirmation message notifies you that the claim will be reprocessed. Click Yes to continue or No if you decide not to recall the claim.

4. If you choose to recall the claim, it opens in a Claims Processing window with an HP (Held/Pended) status to make the needed changes and process it as usual or if the claim is from eFlow, pended recalled claims will go to an eFlow batch if eFlow rules have been set up. Any dates or quantities affected when recalling the claim are returned to the previous state.

   • The claim is removed from any accumulators.
   • If a referral or admission quantity was used, it is backed out.
   • The last update date, is updated.
   • Any prior payment available or adjusted amount is returned to the amount from the original claim.
   • Claim analysis information is updated.

Recall a released claim from Claims History

1. Search and open the member or dependent with a claim to recall.

2. On the Claims menu, select Claim History.

   

3. Locate the released (R—status) claim to recall and right-click it to show a menu.
4. Select Recall Released Claim.
5. A confirmation message notifies you that the claim will be reprocessed. Click Yes to continue or No if you decide not to recall the claim.
6. If you choose to recall the claim, it opens in a Claims Processing window with an HP (Held/Pended) status to make the needed changes and process it as usual or if the claim is from eFlow, pended recalled claims will go to an eFlow batch if eFlow rules have been set up. Any dates or quantities affected when recalling the claim are returned to the previous state.
   • The claim is removed from any accumulators.
   • If a referral or admission quantity was used, it is backed out.
   • The last update date, is updated.
   • Any prior payment amount available is corrected.
   • Claim analysis information is updated.

SEE ALSO