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Managing module bypass

Updated on October 9, 2020

The module bypass function enables specific modules to be bypassed by the claim during processing. This can be applied to create efficiencies in the system when specific event codes have set that need to be resolved before the claim can adjudicate further, or can be applied to skip based on a client contract, external integration rules, etc. The bypass can be configured for all modules, or just specific ones depending upon the business rule.

To access this feature, from the Business analyst portal, click on Configuration in the left-hand navigation panel, then click on Module Bypass.

Each Module is associated with a discrete decision table which contains the specific conditions that drive the bypass functionality. To access the decision table, click on the gear icon associated to the desired module. This displays the decision table which may be modified based on the user’s business need.

The following properties are included as columns in the conditions section of the decision table:

  • Payer ID
  • Plan/Product ID
  • Claim Media Type
  • Claim Type
  • Claim Submission Type
  • Claims Identifier
  • Action Code
  • Event Code

Modifying the decision table

  1. Click the Check out button in the header section.

    After the table is checked out, the user may (a) add or delete columns/properties, (b) add or delete rows, and/or (c) modify data in the rows.

  2. After the user has made all the desired modifications, click on the Save button, then click the Check in button.
Note: If the user wishes to not proceed with the modifications, he/she can click on the Discard button.

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