Rule 201

Owned by vickyp
Last updated: Aug 16, 2017
2 min read

Error message


Description

Make sure you use the right resubmission type.

Claim correction is a resubmission type used in case when you want to resubmit a complete claim. You provide new activities details or correct general claim data (e.g. mistake in MemberID). Activity.ID values must be different from those in the original claim (even if all activities details stay the same). This allows take-backs to be identified unambiguously and simple tracking of the payment terms of the corrected claim. Take-backs do not affect payment terms/fine calculations for the corrected claim.

If you don’t agree with the payer decision on specific activities (like payment amount), you need to send a resubmission with internal complaint type. Activity.ID values of resubmitted activities must be the same as in the original claim.

Note that original claim is the previous version of the claim, it is not necessarily the initial version. For example, there are the following transactions uploaded to Shafafiya for some claim: 

1. Claim.Submission:

  • activity #1 with Activity.ID = 1;
  • activity #2 with Activity.ID = 2.

2. Remittance.Advice (denial).

3. Claim.Submission (correction):

  • activity #1 with Activity.ID = 3;
  • activity #2 with Activity.ID = 4;
  • activity #3 with Activity.ID = 5;

4. Remittance.Advice (partial payment).

The provider performs step 5. Claim.Submission (internal complaint):

  • activity #1 with Activity.ID = 1;
  • activity #2 with Activity.ID = 2.

Uploading will fail since Activity.ID = 1 and 2 cannot be found in the original claim which is the correction (step 3), not the initial claim (step 1).