Claim Correction (Claim Exceptions) Page

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You use the Claim Exceptions panel to resolve exceptions.

Claim Fields

Field	Description
TCN	The transaction control number (TCN) is a unique number assigned by the ND MMIS to each claim.
Status	Indicates the status of the claim. Examples: Paid, To Be Paid, Denied, To Be Denied Update in Claim Correction only.
Member Name	The member's full name.
Member ID	A unique ID assigned to a member
Billing Provider Name	The billing provider's full name.
Provider ID	Unique identifier used for a provider of healthcare services. Format: Up to 15 alphanumeric characters
Claim Type	The type of claim. Examples: Inpatient, Outpatient, Financial Transaction
Trans Type	Indicates the transaction type of the claim. Examples: Original Claim, Void
Location	The location of a suspended claim.
Exceptions Fields Only the Status field can be changed. Convergence Point links to the ClaimsGuard exceptions, if you have access. Not available for dental claims.
LI	The line item number associated with the exception.
Code	The exception code. Exceptions are posted to a claim when edits, which are business rules defined by North Dakota to manage claim processing, evaluate the claim data, and find discrepancies. These may include the absence of required data or the presence of invalid data. The exception code link expands the exception panel to display the exception code details.
Status	The status of the exception. Examples: Suspend, Deny, Deny and Report, Pay, or Pay and Report
Exception Code Detail Fields These fields are displayed when you click the Code link. To hide these fields, click Close.
Exc Code	The exception code.
Exc Desc	The exception code description.
User ID	The ID of the user to whom the claim routed.
User Name	The name of the user to whom the claim routed.
Param Nbr in Error	Indicates the 4-digit number used to identify the system parameter. System parameters are variables that define elements needed for system processing, for example, a parameter may be set up to define the timely filing limit for claims.
Resolution Text	The Resolution Text link displays the first 50 characters of the text that indicates the resolution for the exception.
Read complete resolution text	Links to the Claim Exception page in Rules Management, if you have access.

Field

Description

TCN

The transaction control number (TCN) is a unique number assigned by the ND MMIS to each claim.

Status

Indicates the status of the claim.

Examples: Paid, To Be Paid, Denied, To Be Denied

Update in Claim Correction only.

Member Name

The member's full name.

Member ID

A unique ID assigned to a member

Billing Provider Name

The billing provider's full name.

Provider ID

Unique identifier used for a provider of healthcare services.

Format: Up to 15 alphanumeric characters

Claim Type

The type of claim.

Examples: Inpatient, Outpatient, Financial Transaction

Trans Type

Indicates the transaction type of the claim.

Examples: Original Claim, Void

Location

The location of a suspended claim.

Exceptions Fields

Only the Status field can be changed.

Convergence Point links to the ClaimsGuard exceptions, if you have access. Not available for dental claims.

The line item number associated with the exception.

Code

The exception code.

Exceptions are posted to a claim when edits, which are business rules defined by North Dakota to manage claim processing, evaluate the claim data, and find discrepancies. These may include the absence of required data or the presence of invalid data.

The exception code link expands the exception panel to display the exception code details.

Status

The status of the exception.

Examples: Suspend, Deny, Deny and Report, Pay, or Pay and Report

Exception Code Detail Fields

These fields are displayed when you click the Code link. To hide these fields, click Close.

Exc Code

The exception code.

Exc Desc

The exception code description.

User ID

The ID of the user to whom the claim routed.

User Name

The name of the user to whom the claim routed.

Param Nbr in Error

Indicates the 4-digit number used to identify the system parameter.

System parameters are variables that define elements needed for system processing, for example, a parameter may be set up to define the timely filing limit for claims.

Resolution Text

The Resolution Text link displays the first 50 characters of the text that indicates the resolution for the exception.

Read complete resolution text

Links to the Claim Exception page in Rules Management, if you have access.

Version as of 5/16/14.