Automatic Rebill from Data Changes
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-Automatic Rebill Process
Automatic Rebill Process
Automatic Rebill from Data Changes Clients are added to an automatic rebill queue when certain pieces of information are changed. These pieces are as follows:
Client last name changes
Client first name changes
Client SSN changes
Client benefit plan policy number changes Records from this table are rebilled if the following conditions apply:
The latest response was denied
The date of service is within the last 180 days
The total balance on the claim is greater than 0
The total payment amount is less than or equal to 0
The total denial amount is less than or equal to 0
The latest response is active
The date of service is within the effective dates of the client’s benefit plan record
Automatic Crossover Medicare Claims Claims are automatically crossed over to an MCO Medicaid benefit plan based on the following conditions:
The latest response has not already been followed up on.
The date of service is within the last 180 days.
The total invoice amount is greater than the total payment amount.
The total balance on the claim is greater than 0.
The latest response is active.
The claim is active.
The service and benefit plan on the claim match to a service to benefit plan mapping that maps to a billing configuration that has a receiver ID that equals ‘11502’ – which equals Medicare.
The claim has not already been rebilled, replace, reversed, etc.
The client has an active, effective synced benefit plan record for an MCO.
The total payment is greater than 0 unless the denial reason equals 1. -Automatic Rebill Process
The next benefit plan in line for the claim to be billed to is the MCO based on service to benefit plan mappings and active effective clinician licenses, etc.
The clinician and benefit plan have not been excluded.
The insurance has not been excluded from cross over. *Note: This process runs every 2 hours on Monday, Tuesday, Wednesday, Thursday, Friday and Sunday.