Resolving Errors in Claims

We recommend that users correct claim errors by using the resolution prompt in the Messages tab. The error resolution prompts helps users to edit claims by providing additional context about the source of the error. Additionally, the error resolution prompts organizes allows users to proceed through the editing process and correct each error in an organized, orderly manner.

To access the error resolution prompt, click on any individual error listed in the Messages tab, such as the single error shown in sample image.

Error Resolution Prompt

● As seen in the sample image, each error resolution prompt contains the following details:

● Header indicates the error currently displayed (e.g. “Message 2 of 5”), according to the order that items are listed in the “Errors” section of the Messages tab.

● Use the Prev and Next buttons to navigate between each error or override that is present in the selected claim.

● Each error included in the resolution prompt includes the following details:

o Rule Information:

§ ID/Severity — The unique ID number and severity associated with the error.

§ Name — The name of the error, as displayed in the Messages tab.

§ Date Applied — Specific date and time the error became effective for the error.

§ Override Note (if applicable) — Users can create an override for some errors by entering the appropriate text and then clicking Override Message.

An Overidden By and Override Date section will display (above this field), respectively, with the username and date/time associated with the override. The error will be removed from the “Errors” list and added to list of “Overrides” in the Messages tab.

o Message — This section provides context for the source of the error, by presenting the problem in “if then” form.

For instance, if the Attending Provider NPI field has triggered an “Invalid Attending Physician NPI” error, then the Message section will indicate: “IF The Attending Provider NPI is entered THEN The Attending Provider NPI must be valid”. Help text displayed in this section is unique for each scenario, depending on the related field and error.

o Related Fields — Any fields associated with the error are listed in this section. If applicable, users can directly edit the fields without leaving the error resolution prompt. Simply enter the correct information in the field(s) listed and then click Keep Changes.

o Source — Indicates the source used to establish the criteria that caused the corresponding error to be triggered (e.g. System, CMS NPI requirements, etc.).

● Click Close to leave the error resolution prompt and return to the claim form.

General Process for Editing Claims with Errors

For specific information about Messages tab feature that is used to correct errors that are present in claims, refer to the previous section for details about components that are included in the error resolution prompt.

Outlined below is the general process users can follow for editing claims that contain errors:

1. If necessary, navigate to either Claims | Institutional or Claims | Professional.

2. Find the patient claim that you want to edit. If necessary, use the Quick Search feature.

4. If necessary, click the Messages tab on the right side of the screen. A list of all errors in the claim will display in the Errors section, with the total number of errors shown in parentheses.

5. Open the error resolution prompt to begin working on the claim errors. To open the error resolution prompt, click on one of the error ‘links’ listed in the Messages tab.

6. The error resolution prompt serves as a sort of 'wizard' interface, which includes additional details and features to help you correct errors. You can fix errors directly within these message prompts.

● See Related Fields that are associated with the problem and directly change information directly in the fields without exiting the prompt. Fix the incorrect, or missing, information (as necessary) and then click Keep Changes.

7. After you have properly addressed all errors, click Close return to the claim screen.

8. Hover the mouse cursor over the Transaction tab and then select Save & Validate.

9. Clean claims that are ready to be released can be manually released (by the appropriate user) from the corresponding claims grid (i.e. Institutional, Professional). While viewing the claims grid, select the validated claim, hover the mouse cursor over the Tools menu, and then select Release.