You use the Suspense Release page to add,or edit a suspense release request. A suspense release request releases a group of suspended claims to adjudication.
The Suspense Release page contains the following panels:
| Field | Description |
|---|---|
| Request Date | The date of the request. The date is assigned by the system. |
| Request Number | A unique number that identifies the request. The number is assigned by the system. |
| Request Type | Indicates if the request is to release a batch of claims or a miscellaneous group of claims. The suspense release fields for selection criteria that are displayed depends the option (Batch or Miscellaneous) you select. |
| Field | Description |
|---|---|
| Release this Batch | Select to release the batch to adjudication. |
| Delete this Batch | Select to delete the batch. |
| Release this Batch and Delete Zero Net Change | Release the batch and delete claims that have no change in payment amount upon re-adjudication. |
| Key Fields | |
| Media Source |
Indicates how the claim was received. Examples: Paper, Web |
| Batch Date |
The batch creation date consists of the last two digits of the year and the day of the year. Format: YYDDD Example: February 1, 2011 is 11032. |
| Batch Number |
The number assigned to the batch. The number uniquely identifies each batch of claim documents compiled on a given day. Format: NNNN Example: 9123 |
| Field | Description |
|---|---|
| Line of Business |
The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid. The (LOB) selected identifies what LOB this suspense release request affects. |
|
Criteria Fields These fields further define, within the LOB selected, which claims are released to adjudication. All suspended claims matching the criteria entered are released to adjudication. Only one option can be selected and the associated fields completed for that selection. For example, you can select claims based on provider information and complete the Provider Role, ID Type, and ID fields. |
|
| 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. |
| Provider Role |
The role of the provider. Examples: Billing, Rendering |
| ID Type |
The type of provider ID. Examples: Medicaid, National Provider ID (NPI) |
| ID |
Unique identifier used for a provider of healthcare services. Format: Up to 15 alphanumeric characters |
| Member ID | A unique ID assigned to a member. |
|
ID Type |
Type of member identification, for example, Social Security number or Medicaid ID. |
| Claim Type |
The type of claim. Examples: Inpatient, Outpatient, Financial Transaction |
| Location Code |
The location of a suspended claim. |
| Procedure Code | Indicates the procedure or service provided. Healthcare Common Procedure Coding System (HCPCS) or Current Dental Terminology (CDT) codes are typically used. |
| Modifier 1 - 4 |
A two-digit code attached to the procedure code to modify or clarify the description of the procedure. Up to four modifiers may be submitted on a claim for each procedure code, if applicable. |
| Revenue Code |
Identifies specific accommodation or ancillary charges. |
| Diagnosis Code |
A standard code used to describe the nature of a patient's illness or injury. |
| Benefit Plan ID |
Unique identifier for the benefit plan. |
| All Claims | All suspended claims are released to adjudication. |
Version as of 5/16/14.
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