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Payment

Suggest edit Updated on August 31, 2021

The final step in the processing capabilities of the SCE includes the final payment calculations. This includes the addition of any late payment interest (LPI) as well as setting the final payment amount and member liabilities to apply to the EOBs and provider check run.

The SCE also supports the creation of the appropriate X12 transactions to report claims status and remittance.

CapabilityDescription
Payment calculation

The final payment and liabilities are calculated for the provider payment check run.

  • Set final payment amount
  • Set final liabilities
LPI / prompt pay

Any claims that are subject to late payment interest are identified and the appropriate interest calculations made and applied to the claim.

  • Identify claims for LPI
  • Calculate LPI
  • Identify prompt pay claims
Payment info

Check or EFT information is applied to the claim based on the outcome of the check run process

  • Set final check information
  • Set final paid amounts
Claim/payment response

The SCE can create X12 remittance and claims status information, as well as support claim status inquiries.

  • X12 835
  • X12 277U
  • X12 276/277
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