ServiceXG Basics

Reverse and void a claims batch

Reverse and void multiple pended EDI claims from a trading partner An entity which sends and/or receives electronic health care transactions (i.e.: provider, billing group, billing service, clearinghouse or payer.) or a list of paid claims rather than manually adjusting individual claims. For example, if Anthem voided and re-issued some paid claims, you'll need to void the original claims and then re-issue them. You can create a claims list and reverse them in a batch rather than manually voiding each claim or adjust the original paid claim from a trading partner to a new pended claim (configuration required).

You can reverse and void a batch of paid claims or a batch of pended EDI claims. In the case of EDI claims, you can also use this process to adjust the original paid claim from a trading partner to a new pended claim.

Paid claims

Create a list of claims to adjust, then enter the list on the Batch Reverse/Void screen to reverse (and void, if necessary).

Create a claims list

Go to: Home > Administration Processes > Claims Adjustments > Create Auto Adjustment List

1. To create a new list, enter 1—Manual, or enter the Seq number of an existing list (the instructions below are for creating a new list). Then, press Enter.
   1. Enter the Entry From and Thru date range of the claims to include. Type the date in MMDDYYY format.
   2. The Entry Operator updates with your ID after you tab through it.
   3. Depending on your list type:
      • Enter a name for the Paid Claims list.
      • Enter a name for the 'No Error' Pended Claims list.
   4. To include checks with cleared dates, enter Y at prompt 6, or enter N to remove any checks that have been cleared.
   5. Enter the Pend Code, Fund, or Draft to include in your list at the appropriate W fields. For example, the list shown above will include claims that pended P102.
2. Enter FC—File & Continue to save your criteria or C—Continue to generate the new adjustment list without saving your list criteria.
   • If you chose file and continue, enter a Criteria Name for your list.

3. All claims meeting the criteria you chose are evaluated and any errors are listed in the resulting report (see the Adjustment claims error report descriptions below ). The Process ID Number and the Job Number show in the upper-right of the screen and the results are sent to the spooler The Spooler Manager displays the print jobs and information about each job.. See the Print queue—Retrieve a print job topic.

   Adjustment claims error report descriptions

   Field	Description
   Refno	Reference number of the pended or paid claim. Pended claims are on the left column, paid on the right.
   Rec. Date	Date the operator entered the pended claim.
   DCN	Trading Partner reference number for the pended or paid claim. Pended claims are on the left column, paid on the right.
   Rec. Date	Date the operator entered the pended or paid claim. Pended claims are on the left column, paid on the right.
   Check No.	Check number of the paid claim.
   Draft	Draft of the paid claim.
   Paid Amount	Amount of the paid claim.
   ErrorNo	Number that corresponds to the error description. 1—The P status claim has no register item on file. Reverse these claims manually. The number should be small, if any. 2—Clear date exists on the P status claim. Claims will not receive this error if the criteria is flagged to include claims with cleared dates. The number should be small, if any. 3—P status claim was not found. These claims have already been voided and reversed, and are waiting for the new adjustment claims to be processed. The number should be small, if any. 4—More than one P status claim found. Reverse these claims manually. The number should be small, if any. 5—No errors. These claims are included in the list to be automatically voided and reversed.

4. Review the error report results and follow the directions in the table as appropriate. If you're exporting the report, we recommend printing or exporting in landscape.

Reverse the claims list

Reverse (and void, if necessary) the batch of paid claims.

Go to: Home > Administration Processes > Claims Adjustments > Batch Reverse/Void

5. To enter your own criteria, enter 1—Manual, or enter the Seq number for a saved list (criteria) from the Criteria Window and press Enter.

6. At prompt 1, enter AL to adjust a list of paid claims.

7. Enter Y at Void Check to void the checks in the list. Enter N if no checks were processed.
8. Choose if you will Reissue Claim (s):
   • Enter A to automatically create new claims for the adjusted claims.
   • Enter M to manually create new claims. Enter the pend code for the new claims next.
   • Enter N if you don’t want new claims created.
9. If you chose to manually create new claims, enter the Pend Code for New Manual Claims to apply to the claims. This field isn’t needed if you’re reissuing claims automatically or not creating new claims.

10. Enter the Reason Code (a code that identifies the adjustment reason). Enter ALL to display a window with codes to select from, or type = and a Cross Reference field displays at the bottom of the screen.

    The software includes a list of standard reason codes to choose from, but your system might also have user-defined codes.

    • 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
    • SP—service provider choice error
    • TS—tooth/surface choice error

11. At the select line, enter C.

    

    1. At List of Claims to Adjust, enter the name of the list you created in step 1.
    2. Enter a name for the adjusted claims with no errors at List name of Adjustment Claims with no error. You can use the list in a report to show claims that can be released by an operator or through auto adjudication (go to Displays, Data Preps, Reports >> Claims Processing >> Pend/Pre-Auth/Denial).
    3. Enter a list name for any claims that have errors at List name of Adjustment Claims with error. You can recall the list and revisit these claims at a later time.
    4. Enter C at the select line to continue.
    5. Informational messages display, including the spooler ID. Press Enter to exit the screen.
    6. Review the two generated results on the spooler: one shows any claims that couldn’t be adjusted and why, the other provides the list of claims that can be released or updated. See report examples.

Reverse a batch of pended EDI claims

Reverse ( and void, if necessary) pended EDI claims. You'll have to set up adjustment options in Trading Partner Maintenance Agreement before doing so.

Go to: Home > System Administration > HIPAA > Trading Partner Maintenance

1. Enter the Partner Id. You can also right-click the field and click Advanced Search for a list of all the available partners.

2. Click the Claims Options tab.

   

3. Set the Adjustment Options according to your trading partner's document control number (DCN) format. The fields with asterisk (*) are always required when adjusting pended EDI claims, but depending on your needs, other fields might need to be completed (see examples).

   Examples:

   • The DCN is 012345678904.

     In this example, enter 10 for Matching Length and 2 for Increment Length. The Increment Qty to enter would depend on whether this trading partner increments by 1, 2, 3, etc. If they increment by 2, DCNs 012345678902 and 012345678900 will be searched for.

   • The DCN is 012345678904834.

     Enter the same information as the first example. Additionally, enter 3 for Suffix Length so DCNs 012345678902834 and 012345678900834 will be searched for.

   • The DCN is ANT-0123456789-04-834.

     Enter the same information as the first example. Additionally, set Prefix Length to 4, Suffix Length to 4, and Increment Delimiter to "-" so DCNs ANT-0123456789-02-834 and ANT-0123456789-00-834 will be searched for.

   1. Prefix Length—The length of the DCN prefix.
   2. Suffix Length—The length of the DCN suffix.
   3. Match Length*—The length of the DCN body.
   4. Increment Length*—The length of the DCN increment value.
   5. Increment Delimiter—The character that marks the beginning of the increment value.
   6. Increment Qty*—The increment between DCNs.
4. Click Save Record in the ribbon to save your changes.

Go to: Home > Administration Processes > Claims Adjustments > Batch Reverse/Void

1. To enter your own criteria, enter 1—Manual, or enter the Seq number for a saved list (criteria) from the Criteria Window and press Enter.
2. At prompt 1 enter AP to adjust pended EDI claims.
3. Enter Y at Void Check to void the checks in the list. Enter N if no checks were processed. Prompt 4 defaults to N, and prompt 5 is skipped by default.

4. Enter the Reason Code (a code that identifies the adjustment reason). Enter ALL to display a window with codes to select from, or type = and a Cross Reference field displays at the bottom of the screen.

   The software includes a list of standard reason codes to choose from, but your system might also have user-defined codes.

   • 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
   • SP—service provider choice error
   • TS—tooth/surface choice error

5. At the select line, type C.

   

   1. Enter the Entry From and Thru dates to process.
   2. Enter a name for the adjusted claims at List name of Adjustment Claims with no error. You can use the list in a report to show claims that can be released by an operator or through auto adjudication (go to Displays, Data Preps, Reports >> Claims Processing >> Pend/Pre-Auth/Denial).
   3. Enter a list name for any claims that do have an error at List name of Adjustment Claims with error. You can recall the list and revisit these claims at a later time.
   4. Enter C at the Select prompt to continue.
   5. Informational messages display, including the spooler ID. Press Enter to exit the screen.
   6. Review the two generated results on the spooler: one shows any claims that couldn’t be adjusted and why, the other provides the list of claims that can be released or updated.

   Sample reports

   Claims with no errors

   

   Claims with errors

   

SEE ALSO