The user may also resolve the readmission by manually re-pricing the claim line allowed amount through the guided event resolution process. The user may choose to reprice using a dollar amount, or by configuring a user-defined percentage of the claim line allowed amount; both of which override the existing claim line allowed amount. Upon the completion of the event resolution, the claim line allowed amount is changed according to the user’s choice, the pricing source and methodology are the updated in the adjusted claim line Execution results, and the manual pricing source and methodology are added to the list of pricing source and methodology considerations in the claim line Pricing sources section.

A detailed description of the guided event resolution process for resolving unplanned readmissions is included in Chapter 13, Event Resolution.

• Overview