Replacement: A claim that the payer paid incorrectly, or something about the claim has now changed (staff, units, amount, code, DX, etc.), and you need the payer to reprocess the claim in its correct state.
Reversal (Void): A claim that was previously paid or processed and now you need the payer to either recoup the previous payment, or void all previous submissions of the claim entirely.
Replacement: Shows the payer it's not a duplicate, allows them to compare to what was previously sent
Void: Should of never happened.
Send Reversal/Void or Replacement Claim
- Go to the Billing Module.
- Locate the invoice and double-click to open.
- The Invoice Window will open.
- Locate the service line and double-click.
- The Change Time window will open.
- Make updates to the claim, if necessary.
- Example: Correct the rate on the amounts tab.
- If you're sending a void claim you'll skip this step.
- Go to the Extra Info Tab.
- Replacement/Reversal/Void Claim: Choose Reversal/Void or Replacement depending on what you are doing.
- Report Type Code: Choose the Report Type Code.
- In nearly all instances this will be None. This refers to any extra documentation you may need to send to the payer, such as a copy of an EOB.
- Report Transmission Code: Choose the method of transmission.
- In nearly all instances this will be None. This refers to the way you are sending the extra documentation to the payer, such as a fax.
- Attachment Control Number: Enter the payer's claim reference number.
- Please only include the numbers and letters; there cannot be any extra spaces or characters in this field.
- This number is specific to the service line/claim on the EOB.
- You can find this number on a Procentive ERA (example below) or on the original EOB.
- Claim Reference Number: Enter the payer's claim reference number.
- Some payers may refer to this as the Transaction Control Number (TCN)
- Click Save.
- Complete Steps 3-11 for all services lines that are on this claim.
- Resend each of the affected service lines to the payer.