You use suspense release to request release of claims that have been suspended as a result of adjudication. You can release a batch of claims or a group of claims for a particular line of business based on selected criteria, for example exception code or location code. You can also release all suspended claims. You must follow the guidelines in the Procedures Manual for suspense release requests and have the correct user permissions to perform these functions. Once the request is created on the Suspense Release page, ND MMIS processes the request, selects the claims identified in the request, and sends them to adjudication. If the request has not been processed, you can edit or delete the request.
A claim is suspended when exceptions codes with a status of suspend are posted to it. 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 such as the absence of required data or the presence of invalid data. Certain exception codes are associated with the claim status suspend. Status codes (or disposition codes) indicate how ND MMIS is handling the claim. Depending on the exceptions that post to the claim, ND MMIS assigns a status of To Be Paid, To Be Denied, or Suspended.
How to Search for a Suspense Release Request
How to Add or Edit a Suspense Release Request
Version as of 5/16/14.
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