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The case for event groups

Updated on October 9, 2020

The intent of the Event group feature is to allow the user a simple and efficient process for resolving and reprocessing a limited number of claims, as an alternative to Mass adjustment/reprocessing, or the claims recycle function when configured to an Event code disposition (discussed earlier in this chapter).

The Event group function is considered one of several tools available to the user for claims reprocessing and offers certain advantages over Mass adjustment/reprocessing under certain prescribed circumstances. Consider the following.

Use Case

A recently negotiated provider contract will not be configured in the payer’s claim system in time for the first date of the new contract year; consequently, all future claims associated to the provider are in jeopardy of paying incorrectly.


Payer and provider agree that in order to avoid the incorrect payment of future claims, all claims with dates of service on or after the first date of the new contract year will be suspended until the new contract has been configured. Payer will deploy OOTB Event code SGB-0009: Contract Configuration Incomplete in order to hold those claims, and then create an Event group instance and associate it to Event code SGB-0009.

As a result, all claims associated to the provider beginning on the first day of the new contract year will be suspended and captured in a single Event group. When the contract is configured the payer will end date the Event code and manually resolve that event on a single claim belonging to the Event group. When that single event is manually resolved, SCE will automatically resolve the same event for all the remaining claims in the Event group.

SCE provides a great deal of flexibility to the user in adjusting and reprocessing claims through its Mass adjustment/reprocessing, Event group, and Claims recycle features. Those features are summarized and compared in the matrix below.

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