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 |
---|---|---|
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 |
|
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: CES 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 |
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 |
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 |
The edit will be marked in the Edits window as resolved. |