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Intake

Suggest edit Updated on August 31, 2021

The intake capabilities are responsible for ingesting a claim into the system, creating the claim case for management, and ensuring that the transaction is valid by performing field level validations.

Resubmission of claims for voids or adjustments are also handled through intake. The creation of a control number for processing and claim identification is the final step of intake.

CapabilityDescription
EDI/API/XML

The SCE supports the electronic intake of claims via X12 EDI and XML transactions as single or batch files. The SCE also provides an API for intake.

  • Claim parsing
  • External pended claims
  • X12 837 I, P, D
  • Batch files
  • Claim case creation
Manual entry

The SCE provides a series of user interfaces to manage the manual entry of claims.

  • Medical and dental claim types
  • Claim case creation
Field validation

The SCE validates fields on the transaction for formatting and code related errors as part of the intake parsing.

  • Format errors
  • Code errors
Claim resubmission

If the claim is identified as a resubmission or void of an existing claim, the SCE matches the new claim to the original claim and performs the secondary processing to appropriately adjust or void the claim.

  • Claim match
  • Void & resubmit
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