How to Add or Edit a Claim Exception

You can add or edit a claim exception code and related details like disposition, routing locations for a specific line of business (LOB), resolution information, and response information.

You can also copy or replicate the existing claim exception to create a new claim exception.

When editing, a warning message is displayed to inform you that the change affects all associated LOBs. You are then prompted to verify the change is to be made when you are:

• Copying a claim exception to another line of business (LOB)
• Adding a new LOB to an existing claim exception
• Replicating a claim exception within the same LOB

Optionally, you can:

• Delete the entire claim exception code.
• Delete detail information from the claim exception code. Delete drug-level messaging, claim routing, RA text override, or disposition key detail information.
• Replicate a claim exception. Copy a claim exception within the same line of business.
• Copy a claim exception. Copy a claim exception to another line of business.

• View or add notes. To view or add notes for this record, on the action bar, click Notes.

• View audit details. To retrieve audit information, close any open panels and, on the action bar, click Audit Log. To view the details for a particular record, click Audit.

• Reset your entries. To clear the fields and remain on the page or panel, click Reset.
• Cancel your entries. To close the page or panel without saving your changes, click Cancel.

To add or edit a claim exception

1. On the Rules Mgmt menu, click Claim Exception.
2. Search for the claim exception code you want to add to make sure that it doesn't exist or that you want to edit.
3. To add or edit a claim exception code, do one of the following:
   • To add, click Add Claim Exception.
   • To edit, continue to the next step.
4. On the Main tab of the Claim Exception page, in the header panel, complete the fields, if needed.

5. Add or edit detail information on the following tabs:

   • Main (default overrides)
   • Disposition
     • For a medical claim exception code
     • For a pharmacy claim exception code
   • Resolution
   • Response

   Note: Resolution and Response data apply to all lines of business (LOBs), so if you update these when copying or replicating an exception code, you are updating them for all LOBs.

6. On the Claim Exception action bar, click Save.

See Also

Claim Exception (Main Tab) Page

Claim Exception (Disposition Tab) Page

Claim Exception (Resolution Tab) Page

Claim Exception (Response Tab) Page

What Is Claim Exception?

About Rules Management

Version as of 5/16/14.