<p> -Automatic Rebill Process</p><p>Automatic Rebill Process</p><p>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:</p><p> Client last name changes</p><p> Client first name changes</p><p> Client SSN changes</p><p> Client benefit plan policy number changes Records from this table are rebilled if the following conditions apply:</p><p> The latest response was denied</p><p> The date of service is within the last 180 days</p><p> The total balance on the claim is greater than 0</p><p> The total payment amount is less than or equal to 0</p><p> The total denial amount is less than or equal to 0</p><p> The latest response is active</p><p> The date of service is within the effective dates of the client’s benefit plan record</p><p>Automatic Crossover Medicare Claims Claims are automatically crossed over to an MCO Medicaid benefit plan based on the following conditions:</p><p> The latest response has not already been followed up on.</p><p> The date of service is within the last 180 days.</p><p> The total invoice amount is greater than the total payment amount.</p><p> The total balance on the claim is greater than 0.</p><p> The latest response is active.</p><p> The claim is active.</p><p> 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.</p><p> The claim has not already been rebilled, replace, reversed, etc.</p><p> The client has an active, effective synced benefit plan record for an MCO.</p><p> The total payment is greater than 0 unless the denial reason equals 1. -Automatic Rebill Process</p><p> 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.</p><p> The clinician and benefit plan have not been excluded.</p><p> The insurance has not been excluded from cross over. *Note: This process runs every 2 hours on Monday, Tuesday, Wednesday, Thursday, Friday and Sunday.</p>