Create a Corrected Claim

A correction in the RCM occurs when one or more components of information change, which alters the content of an existing claim.

How Do Corrections Work?

There are two methods with which corrections can be generated: by the system or by a user.

System Generated Corrections

The system checks for corrections every night by cross-referencing any changes to patient demographics, recorded services, and system configuration against any open claims where the original information was present. Claims flagged for possible corrections will then display in the Work Center > Insurance Claims > Create Corrected Claims section of the RCM. 

User Generated Corrections

Users can check for corrections instantly by navigating to Patient > Treatment Episode > Insurance Billing > Review Corrections and clicking Check For Corrections. The system uses the same nightly process to check for corrections instantly, but may also include closed claims. This workflow is beneficial for users who need to verify in real time that changes made will produce the desired corrections. 

Correction Types

There are four correction types that the system will look for and flag. Once the system flags a claim as a potential correction, users should view and compare the proposed changes to determine the best course of action.

• This correction is generated when one or more pieces of information that the claim was created with have been changed in the RCM. Select the Compare quick link to review the changes made. Information highlighted in red indicates changes made by the user, and information highlighted in green indicates changes made by the system. 
• This type of correction is flagged when the claim form type is attempting to convert. These corrections often recur as a result of changes to the billing profile or the creation of a service grouping rule.
• Voided claim corrections are flagged when all days of service recorded on a claim have been unsubmitted from the Attendance Calendar. For more information on generating voids, click here.
• Corrections flagged as new indicate that a change has been made by the user that affects only some of the dates of service, but not all. As a result, the system will attempt to split the claim based on the effective date of the change. Clicking View will display the information that is being separated and created as a new claim. 
• Potential corrections tagged as Errors indicate the system is trying to create a correction based on changes made, but one or more components are missing. Click View for additional details on the source of the error. 

Create Corrections

Once you have reviewed the changes and confirmed they are correct, the correction can then be generated by the user or the system. Let's review the process together!

1. Navigate to Work Center > Insurance Claims > Create Corrected Claims. 
2. Review the correction and click Resolve.
3. Select one of the following actions:
   • Create Corrected Claim to generate the correction.
   • Ignore to dismiss the correction.
   • Re-check in 24 Hours to instruct the system to ignore the corrections for 24 hours.
     
4. Input the Internal Control Number to instruct the system to include a 7 as the bill-type suffix/resubmission code.
5. Toggle on Submit as New Claim to bypass the ICN requirement.
6. When applicable, include Box 80 Remarks and Notes.
7. Next, tag an issue to the claim to help identify why the claim was corrected. Note that this information will not be in the claim.
   
8. Add any applicable condition codes.
9. Finally, click Resolve to complete the process.

Correction Troubleshooting

Refer to our correction overview article for more information on corrections and troubleshooting them.