Actions menu
On the right side of the claim user interface, the banner across the top of the screen offers access to the Actions menu. The Actions menu will display different options, depending on your role, the status of the claim, and whether the claim is assigned to you.
Available actions are:
| Action | Description |
| Adjust and restore | Initiates claim adjustment and restores claim to original submitted data. This option is available for claims with a Pending-Approved or Resolved status. (For more information, see Claim adjustments topic in this section) |
| Claim adjustment | Initiates a claim adjustment. This option is available for claims with a Pending-Approved or Resolved status. (For more information, see Claim adjustments topic in this section) |
| Claim correction | Opens pre-defined fields on the claim to allow update or correction of claim data. This option is available for claims that have not been resolved. |
| Delete | Deletes the claim from SCE. AVAILABLE ONLY IN TEST ENVIRONMENTS. |
| Deny claim | Allows you to deny a claim outside of event code resolution. Opens a screen to enter the denial reason, the claim adjustment group code, the CARC (claim adjustment reason code), the RAR (remittance advice code), and any notes related to the denial. Once the required fields are populated and Submit is selected, the claim is denied. |
| Follow | Following a claim adds the hyperlinked ICN to the “Following” slot or widget on your dashboard. |
| Force complete | Forces the finalization of the claim, regardless of open events. Choose the option and click Submit. The finalized claim status will be Resolved-Complete. AVAILABLE ONLY IN TEST ENVIRONMENTS. |
| Help | Provides mapping between the claim user interface and X12 and paper claim fields. |
| Manage related claim | Allows you to manually relate claims to each other by choosing a category like duplicate, adjustment, authorization and selecting claims that are related to your claim for the chosen reason. (For more information, see Related claims topic in this section) |
| Preview execution | Creates a “Before claim” and “After claim”, allowing you to preview the results of actions taken on the claim or claim line. |
| Process immediately | Selecting “Process immediately” and clicking Submit immediately reprocesses the claim and displays the result. |
| Refresh | Refreshes the claim screen. |
| Restore | Restores the claim to the originally submitted data. |
| Reverse split | When the claim status is Resolved-Split, the Reverse split option is displayed. Reversing a split voids or cancels the split claims and applies a Resolved-Cancelled or Resolved-Voided status to the originally split claim. A new claim with all the original lines is created and sent for processing. (For more information, see the Manually splitting claims and claim lines topic in this section) |
| Split claim | Allows you to split the claim into two or more claims. Select the option, then click Split claim. SCE will guide you through splitting the claim, ensuring everything balances. You are required to select a split reason. The original claim will display a Resolved-Split status. (For more information, see Manually splitting claims and claim lines topic in this section) |
| Split claim line | Allows you to split a claim line into two or more new claim lines. Select the option, then choose “Split” from the vertical ellipsis menu displayed to the right of each claim line. SCE will guide you through splitting the claim line, ensuring everything balances. (For more information, see Manually splitting claims and claim lines topic in this section) |
| Stop following | Removes the ICN from the “Following” slot or widget on your dashboard. |
| Transfer assignment | Allows you to transfer the claim to an operator, reporting manager, work queue, work group or work group manager. You may add a note. Advanced options allow you to adjust the urgency of the claim, add instructions and select a date when the assignment should be active. |
| View claim history | Provides access to multiple tabs: Claim: displays the closed event codes, action codes, and an information log. Process: Displays a detailed audit trail each time the claim is processed or reprocessed. Measurement: Displays the start, end and total elapsed time for every module encountered by the claim for each time the claim is processed or reprocessed. Also captures the total claim processing time. ClaimsXten: Populated when claims are sent to ClaimsXten via SCE for editing. Captures the request and response XML as well as the execution sequence time. NetworX Pricer: Populated when claims are sent to NetworX Pricer via SCE for pricing. Captures the request and response XML as well as the execution sequence time. |
| View claim skills | Displays the skills that have been assigned to the claim during
processing. Note:This option is only available when skills are configured. |
| Visualize claim process | Displays a graphic representation of how a claim has processed through SCE’s various modules. By clicking on each module from the Visualize Claim Process screen, you can see the progress of the claim through the selected module.
Note: To view Visualize claim process, the Audit and Measurement options on the Configuration page in Designer Studio must be enabled. |
| Void/Cancel | Voids or cancels the claim, depending on its status. Choose the option and click Submit. |
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