Guided Processing System (GPS) actions

The following are edit conditions that could occur during claims processing, the actions you can take, and the possible results.

Condition

Action

Result

Edit requires entry in claims window

Change data (or don't) then click next to move to the next edit.

The edit will be marked in the Edits window as tentatively resolved. The next time validate is called, the subroutine will make the judgment whether this edit is actually resolved.

Edit requires entry in ServiceXG

Change data (or don't) then click next to move to the next edit.

You can’t or choose not to resolve the Edit for any reason

Click next to move to the next edit.

Edit requires response

Answer the prompt (either button, list or other prompt).

The edit will be marked in the Edits window as resolved. Any codes or updates that need to be made in the claim are updated.

CES Edit requires response Click the CES button and click Yes or No to the message: CESClosed An on-line claims edit that checks the CPT and ICD codes within a claim and verifies that the coding is appropriate. The operator automatically receives notification of any claim issues. has been applied. Do you want to remove it? If you click Yes, the CES edits and the CES button are removed. If you click No or close the message, the CES edits remain.

Edit requires no response

Click next to move to the next edit.

The edit will be marked in the Edits window as tentatively resolved. The next time the validate process is called, this edit is resolved.

Audit occurs after an Edit is resolved

Initiates save process. This causes an Audit.

If you have sufficient permission to view or work the audit, then the Edits window displays with a yellow icon to indicate the pend resolution caused another condition. In this case, an audit.

Manually resolved Edits and Audits

Choose Resolve on the Navigator. Optionally, you can check the box to apply to all manual pends (not including audits).

The edit/audit will be marked in the Edits window as resolved. With the check box selected, all manual edits will be marked as resolved, if original edit was a pend type edit. All audits will also be marked as resolved, if original edit was an audit type edit.

Edit requires response via dialog

Selecting OK resolves the edit.
Selecting Cancel keeps the edit assigned.

The edit will be marked in the Edits window as resolved.