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About voiding or cancelling Medicaid Subrogation Demand 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 Medicaid Subrogation Demand 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 Medicaid Subrogation Demand claim, and replaces it with a new claim. In the Claims History tab, you can see the link between a new Medicaid Subrogation Demand claim and the previously submitted claim.
  • If the status of the previously submitted Medicaid Subrogation Demand claim is not Resolved - Completed, Pega Smart Claims Engine for Healthcare changes the status to Resolved - Cancelled.
  • If the status of the previously submitted Medicaid Subrogation Demand claim is Resolved - Paid Status, Pega Smart Claims Engine for Healthcare changes the status to Resolved - Voided.
  • If Pega Smart Claims Engine for Healthcare cannot find the original Medicaid Subrogation Demand 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 original Medicaid Subrogation Demand claim.
  • If the status of the previously submitted Medicaid Subrogation Demand claim is not Resolved - Completed, Pega Smart Claims Engine for Healthcare changes the status to Resolved - Cancelled.
  • If the status of the previously submitted Medicaid Subrogation Demand claim is not Resolved - Paid, Pega Smart Claims Engine for Healthcare changes the status to Resolved - Voided.
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