Reconciling and Resubmitting Claims with 5.13.3

Reconcile Rejected/Denied Claims
By going to Medicaid – Service Bureau Claiming, users can access the Reconcile Denied Claims Screen and the Reconcile Rejected Claims Screen. The correction and resubmission process that follows is the same for both rejected and denied claims.
  1. By right-clicking an unreconciled claim, users have the option to resubmit it without changes, or edit and resubmit it. If a claim is rejected or denied for a reason unrelated to the claim itself, such as a provider being unaffiliated with Medicaid, the user can resubmit the claim without making any changes to it. On the other hand, if a child has an invalid CIN or ICD 10 code, users can edit the claim before resubmitting it.
Edit and Resubmit Claims
If a user double-clicks a claim on the Reconcile Denied Claims or Reconciled Rejected Claims Screens, or right-clicks a claim and selected Edit Claim and Resubmit, they will open the Edit and Resubmit Claim screen.
  1. Each claim will now show its original provider. Even if a claim is no longer associated with that provider, the vendor listed will be the original provider at the time of the claim’s submission. Like keeping a record of a child’s CIN at the time of a claim’s submission, users can look back at rejected and denied claims to see if anything was wrong with the provider to cause the rejection or denial.
  1. The dropdown menu of batches will now no longer display batches that have already been submitted.