Internal complaint is a claim resubmission type used in case when provider does not agree with the payer decision on specific activities. Only disputed activities are sent with internal complaint.
Claim resubmission can be created for a claim in Rejected By Payer or Partly Paid By Payer statuses.
Step 1. Select (Incomplete) value from Status drop-down list.
The search results grid appears.
Step 2. Set focus on any claim and click on Resubmit claim complaint link label.
Claim Details dialog appears in edit mode.
You can set / modify the following data here:
(1) resubmission comment;
(2) attachment;
(3) amount to resubmit.
Step 3a. Enter any text in Resubmis. comment. It is a mandatory field.
Step 3b. Click on Add file for resubmission link label. In the dialog appeared find the necessary file in .pdf format and click on Open button.
The file can represent medical report, lab results, prescription, authorization approval copy, purchase invoices or anything else the payer may request.
As a result, new options appear:
- View attached file link label – by clicking on it the file opens for viewing;
- Remove attached file link label – by clicking on it the file removes from the claim and Attach file for resubmission link label becomes available again.
Step 3c. Edit Amount to Resubmit. Denial Amount is copied here by default.
Denial Amount = Net – Payment Amount
If you want to resubmit all the amount denied, just leave Amount to Resubmit untouched.
Total amount to resubmit = sum (Amount to Resubmit)
Step 4. Click on Save Resubmission button.
Claim Details view closes. The claim status changes to Ready for Resubmission.
As soon as resubmission is created, Edit claim option becomes available (learn more). You still have an ability to modify the data before generating e-claims batches.