Click HERE for a pdf version of this Claims Management Reprocessing Help page.

Assumptions

The following information for Claims Management Reprocessing is created for the Billing User. An understanding of the Fiscal Overview functions and the Basic Billing Workflow is assumed for the following examples. Click HERE to review the Fiscal Overview section.

Overview

Claims Management Reprocessing

There are times when the Charge created for the Service is incorrect or must be submitted more than once. In addition, missing Payer-specific modifiers, delayed communication regarding changes in Client coverage, rebilling a claim denied in error, and retroactive Payer rate changes require some flexibility after the Create Charges and Create Bills processes. In EchoVantage, these types of changes are handled by the reprocessing options in the Action drop-down box on the Claims Management screen. These options are listed below.

Rebilling Outgoing and Denied Charges
Reprocess Active Payer
Reprocess All Payers
Reverse Service Transactions

Which Action Do I Need to Choose?

Understanding which Action to use helps achieve the desired result quickly and without unintended extra work. The following table gives a brief overview of each Action. A detailed description, with examples, is contained in the following sections.

Reprocessing Action	Use When
Rebilling Outgoing and Denied Charges	Nothing about the Charge needs to change.
Reprocess Active Payer	Only the Charge information for the Active Payer needs to be modified. Nothing needs to change for a previous Payer.
Reprocess All Payers	All Charges for all Payers need to be modified, but nothing needs to change about the Service.
Reverse Service Transactions	Service information needs to be modified.

Rebill Outgoing and Denied Charges

The Rebill Outgoing and Denied Charges action sets the Charge Status back to Active, so it may be rebilled using the Fiscal Overview > Unbilled Charges > Create Bills screen. The Action only affects the currently active Payer and requires the Charge Status to be either Outgoing or Denied. This is the only job that does not require a job message as it simply resets the Charge Status (dbo.Charges.Status changes from ‘O’ to ‘A’ in the database), making the Charge immediately available to select in a Create Bills job. This Action does not correct or update rate and unit calculations or modifier changes; these are determined during the Charge Creation process.

Example

Client Sandy Beach received an ADP Service on 06/01/2021. The Service was processed, and a bill for $50.00 was created. The Payer initially denied the claim due to an incorrect Policy Number. A quick investigation determined the Policy Number was updated, but not until after the Bill for the Service was created. Rebilling the Charge will fix the Policy Number issue so the Payer will remit payment. The following example allows the Denied Charge to be included in a new Create Bills job.

To Rebill the Charge, select the Rebill Outgoing and Denied Charges option in the Action drop-down list.

The Transaction Date defaults to the current date, and both the Message and Transaction Date fields are not editable. Click on the blue CONTINUE WITH RESULTS button to proceed; a confirmation box displays indicating the number of selected Claims that can be set back to Active.

Select the blue REBILL button to complete the process. The Charge is returned to Active Status, as shown below.

This Charge is now available to select in the Unbilled Charges > Create Bills screen.

Reprocess Active Payer

Select Reprocess Active Payer when a new Create Charges calculation is needed. Only claims with a Charge Status of Active or Outgoing are reprocessed with this Action. Reprocessing Active Payer voids the current Charge, related copay, and associated payments by creating reversing entries. The original Charge and the reversing Charge are marked as void in the database to preserve the transaction history. The reprocessing Action creates a new charge, so changes in charge calculation, unit calculation, and modifiers are picked up. Reprocessing also creates a copy of the original remittance with a Status of Reprocessed to facilitate finding and applying a previous payment. Like the rebill Action above, Reprocess Active Payer sets the Charge Status from Outgoing to Active.

Enabling the Show Reprocessed Charges toggles confirms there are currently no reprocessed charges.

For this example, the current rate is end-dated, and a new rate is entered that encompasses the Service date for the Payer and ADP Service, Configuration > Services/Payers > Payers > Rates. After reprocessing, the new Charge will be $35.00, NOT $50.00.

Create the Reprocessing Job

From the Claims Management screen, filter the results or select the claim to be reprocessed. Then select Rebill Active Payer in the Actions drop-down, enter a job Message, and enter the Transaction Date.

The Message is used to identify the job on both the Reprocessing History and the Reprocessing Errors screens.
The Transaction Date is used to determine the GL Posting Period and defaults to the current date but may be edited. The default date was used in the example to make identifying the original and new charges easy.
Depending on your agency’s fiscal policies, the Transaction Date may be the same as the Service Date of the original Charge, in the same month, or the actual date of reprocessing.

Note that if individual claim checkboxes are selected, the blue button message changes from CONTINUE WITH RESULTS to CONTINUE WITH SELECTION.

Select the blue CONTINUE WITH RESULTS (SELECTION) button.

A confirmation box appears indicating the number of claims that meet the job requirements out of the total claims selected. Select the blue REPROCESS button to create the reprocessing job.

Look for a green success toast to display in the upper right-hand corner, then navigate to the Reprocessing History screen.

Review and Finalize the Reprocessing Job

The Reprocessing History screen displays unfinalized jobs first with a secondary sort by Date from most recent to oldest. Jobs with a Status of Pending, In Progress, Failed, or Preview are considered unfinalized. Jobs with a Done or Reversed status are displayed after unfinalized jobs, sorted by Date from most recent to oldest.

The example Reprocess Active Payer job is at the top of the list in the image above; the row is selected to show the job Details. As expected, the (new) Current Active Charge is $35.00.

In EchoVantage version 3.25+, while the reprocessing job remains unfinalized, the Claims Management screen shows the original Claim as Reversed with a dash for both the Active/Last Payer and the Charge columns. Select the job row to view the Claim Details.

The image above shows the details with the Show Reprocessed Charges toggle enabled. The entries created by reprocessing are outlined in red. Both the reversing entries and the new charge items have PRECHARGE status while the job remains unfinalized. Return to the Claims > Reprocessing History screen, select Finalize to complete the reprocessing job. A green confirmation box should display in the upper right-hand corner.

Finalized Reprocessed Active Payer Claim

Returning to the Claims Management screen, the Charge Status is now Active, and the Charge (amount) is $35.00.

Finalized Reprocessed Active Payer Claim Details

Select the row again to view the Claim Details. Only the current (newly created) charges display when the Show Reprocessed Charges toggle is not enabled

Create Bills for the Reprocessed Charge

These now Active charges (Payers CC and SELF) are available to include in a Fiscal Overview > Unbilled Charges > Create Bills job. Once a Create Bills job is processed and finalized, the Charge Status is updated to Outgoing. This step may not be required depending on your reasons for reprocessing. If there is no need to send a corrected bill to the Payer, it is OK to move on to the Apply the Reprocessed Payment section.

Apply the Reprocessed Payment

After the Active Payer is reprocessed and bills are created (if needed), the copy Remittance can be applied.

Select the Reprocessed Remittance to view the Remittance Details.

The Status is Reprocessed, and no charge is selected. To apply the Reprocessed Remittance, change the Status to Not Ready and select the appropriate Charge.

Save and mark Ready on the Remittances screen or change the Remittance Status to Ready before saving, depending on your specific workflow. In the example above, the status was changed to Not Ready, the correct Charge was selected, and then the status was updated to Ready before SAVE was selected. Once the remittance is marked Ready, it is available to include in a Fiscal Overview > Unprocessed Remittances job. The image below shows the updated Claims Management record after the remittance is processed and finalized.

The Payer Balance is $0.00, and the Client Balance is $10.00.

Reprocess All Payers

Reprocess All Payers creates reversing entries for the existing charges, copays, and any related payments for ALL PAYERS, not just for the currently active Payer. Reprocessing All Payers follows the same process as outlined in the Reprocess Active Payer section above.