ServiceXG Basics

Find a trading partner claim’s adjustment reason

To track why and when an adjustment is done on a paid (claim status—P) trading partner (BCBS, Anthem, UHC, etc.) claim, see the Adjustment Reason tab.

• The claim must be in a P—paid status and you must have the proper access to view or use this tab.
• Once a claim has been adjusted, the Adjustment Reason fields are disabled and the information is available to help answer trading partner claim adjustment questions.

Add adjustment comments

1. Search for and open the paid claim to adjust.
2. Select the Claim Payments option from the Claim menu.

3. Click the Adjustment Reason subtab.

   

4. Click and select a Request Date or type a date in the MM/DD/YYYY format. Your ID shows as the Operator automatically.
5. Select an adjustment reason from the Reason list.
6. At Cancel Date, click and select the date the transaction was canceled or type a date in the MM/DD/YYYY format.
7. If needed, enter Comments to clarify the claim adjustment.

8. Click to add your adjustment information to the member's claim record or click to clear all selections.

   Note: You can update the Adjustment Reason tab until the claim is adjusted.
   Hint: To update multiple claims, use the batch process. See Make several adjustment update requests at once (batch).

View claim adjustment comments

1. Search for and open an adjusted claim (AP).
2. Select the Claim Payments option from the Claim menu.

3. Click the Adjustment Reason subtab.

   

SEE ALSO