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.
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.
The SCE provides a series of user interfaces to manage the manual entry of claims.
The SCE validates fields on the transaction for formatting and code related errors as part of the intake parsing.
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.