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Intake

Updated on December 15, 2021

The intake capabilities are responsible for ingesting a claim into the system, creating the claim case for management, and ensuring that the transaction is valid by performing field level validations.

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Resubmission of claims for voids or adjustments are also handled through intake. The creation of a control number for processing and claim identification is the final step of intake.

CapabilityDescription
EDI/API/XML

The SCE supports the electronic intake of claims via X12 EDI and XML transactions as single or batch files. The SCE also provides an API for intake.

  • Claim parsing
  • External pended claims
  • X12 837 I, P, D
  • Batch files
  • Claim case creation
Manual entry

The SCE provides a series of user interfaces to manage the manual entry of claims.

  • Medical and dental claim types
  • Claim case creation
Field validation

The SCE validates fields on the transaction for formatting and code related errors as part of the intake parsing.

  • Format errors
  • Code errors
Claim resubmission

If the claim is identified as a resubmission or void of an existing claim, the SCE matches the new claim to the original claim and performs the secondary processing to appropriately adjust or void the claim.

  • Claim match
  • Void & resubmit

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