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About voiding or canceling Reporting claims

Suggest edit Updated on April 26, 2021

Based on the value in the Type of Bill field, Pega Smart Claims Engine for Healthcare voids or cancels Reporting claims.

Frequency code = 7

  • If the frequency code of the Type of Bill value is 7, Pega Smart Claims Engine for Healthcare automatically voids or cancels the previously submitted Reporting claim, based on the original payer claim control number (REF01 = F8), and replaces it with a new Reporting claim. In the Claims History tab, you can see the link between a new Reporting claim and a previously submitted Reporting claim.
  • If the status of the previously submitted Reporting claim is not Resolved - Completed, Pega Smart Claims Engine for Healthcare changes the status to Resolved - Cancelled.
  • If the status of the previously submitted Reporting claim is Resolved - Paid Status, Pega Smart Claims Engine for Healthcare changes the status to Resolved - Voided.
  • If the application cannot find the original Reporting claim, it pends the current Reporting claim for user action.

Frequency code = 8

  • If the frequency code of the Type of Bill value is 8, Pega Smart Claims Engine for Healthcare automatically cancels or voids the Reporting claim based on the original payer claim control number (REF01 = F8).
  • If the status of the previously submitted Reporting is not Resolved - Completed, Pega Smart Claims Engine for Healthcare changes the status to Resolved - Cancelled.
  • If the status of the previously submitted Reporting is not Resolved - Paid, Pega Smart Claims Engine for Healthcare changes the status to Resolved - Voided.
  • If Pega Smart Claims Engine for Healthcare cannot find the original Reporting claim, it pends the current Reporting claim for user action.
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