You can transfer historical claims to another member in ND MMIS when claims have been assigned incorrectly using the Transfer Claims function of Member. You also can verify that claims marked for transfer from one member ID to another ID as a result of a request to merge two member IDs should, in fact, be merged.
Note: You must have the permissions necessary to access the Claims Transfer function, and the source and target members must exist in the system.
Claims can be incorrectly assigned because of the following:
In either case, two different members' claims are now intermingled under the same member ID and need to be assigned to the correct ID. You use this function to select the claims that should be transferred to another Internal System ID.
The Member Claims Transfer page includes a list of paid, to-be-paid, denied, and to-be-denied claims for the source member. You are allowed to search for and select the target member ID in this view and the individual claims for transfer (unmerging).
After the transferred claims have been approved on the Member Claims Transfer page, a claim adjustment request is generated for each selected claim to transfer the claim from the source to the target member ID, along with any used amounts or units for spenddown, service authorization, and benefit service limits.
How to Maintain Suspect Duplicates
Version as of 5/16/14.
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