The Claim Edits tab lets you configure specific edits that can be used against a claim being processed. Claim edits are defined by claim type.

Once you open a claim, additional parameters for claim edits at the Claim Type level are:

• Billing – Indicates whether claims are processed for billing purposes.
• Reporting – Indicates whether claims are processed for reporting purposes.
• Processing – Indicates the level of processing for payment of claims (Header or Detail).
  • If the processing level is Header, the payment is made at the claim level once all claim lines (Detail) have been completed and approved.
  • If the processing level is Detail, payment is made at the claim line level as it is completed and approved.

• Claim type identification link
• Claim Submission Type Mapping link
• Manipulating Claims Edits

• Core Configuration