Rule 118

Owned by vickyp
Last updated: Aug 17, 2017
1 min read

Error message

Description

The following process must be followed:

  1. Provider sends Claim.Submission -> claim status is Claimed.
  2. Payer answers with Remittance.Advice (denial) -> claim status is Remitted.
  3. Provider resubmits Claim.Submission (internal complaint or correction) -> claim status is Claimed.
  4. Payer answers with Remittance.Advice (payment or denial) -> claim status is Remitted.
  5. Provider sends Claim.Submission again (internal complaint or correction) -> claim status is Claimed.

and so on.

Error on rule 118 appears on step 3 if step 2 wasn't taken yet (or on step 5 when step 4 wasn't taken). The claim is still in Claimed status but resubmission is possible for remitted claim only. In other words, two resubmissions in succession are not allowed.