How do I send a claim correction through EDI?
Some insurances will accept a claim correction through EDI. To accomplish this on the Unicentric system, you need to change a segment in the Bill Setup, and re-submit the batch through EDI.
Copy the setup file
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To send using the "Cliam Correction" code you will need to have a Bill Setup file with that information. The easy way to accomplish this is to create a copy of the current Bill Setup file, and update the segment. This is done under Tools > Bill Setup.
Open the current setup file
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Click on the EDI setup file, then click "Show XML Data"
Copy the contents of the text area
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You can leave the copy in your buffer, or paste it to a txt file (notepad,word,textmate,etc)
Create a new Bill Setup
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Create a new setup file, and name it the same as the one you copied along with "Claim Correction". This will allow you to remember what it is for.
Add the XML contents from the copy
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Click "Show XML Data" to display the textarea. It should be blank or contain the base node. Replace everything with what you copied from the original setup.
Save the new setup file
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Save the setup file by clicking the Save Setup icon.
Update Claim Correction Node(s)
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Claim/FrequencyCode = Change the value from “1” to “7”. You can also send it as a void by using “8”
Claim/Note = If it’s a correction “7”, some insurances will require a note explaining the change (80 characters)
Edit the new setup
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Click on the setup name in the list to edit.
Edit Claim/FrequencyCode
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Edit the value for this node from "1" to "7"
(optional) Edit Claim/Note
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If you know that the insurance company needs this value, enter it here.
Save the new setup file
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Save the setup file by clicking the Save Setup icon.
Isolate the batch to resubmit
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The next thing to do is to get the claim that needs to be resent into its own batch. This is done from the Tools > Billing > 3PB page. Check the Contact in the grid, and click "Resubmit (EDI) Checked". This will pull the claims for the contact and add them to a new batch.
Update the Bill setup for the Insurance Company
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You will need to update the Bill Setup that the insurance uses to point to the “Claim Correction” one. This is done under Tools > List Maintenance > Payment Sources. Change the EDI Setup File to use the updated one, and save.
NOTE: You will want to do this step when no other batches are being sent. Once the setup file is changed, all EDI files for this insurance will have the "Claim Correction" code.
Mark the batch for EDI
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Include the batch for EDI, and click the "Create EDI File" button.
Switch the Bill Setup back
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Once the EDI has been generated, switch the setup back to the non "Claim Correction" one