If your role and privileges allow, you can split a single claim into one or more claims; you may also split a single claim line into one or more claim lines.
To split a claim, select the Split claim option from the Actions menu for any claim assigned to you.
Smart Claims Engine displays the Split claim slot. Click Split claim to begin.
A modal is displayed, allowing you to enter the total number of claims you wish to create. A system setting controls the maximum number of claims which may be created from a single claim; if your entry exceeds this number, an error message will display.
Enter your desired number of claims and click Submit. Smart Claims Engine creates the number of claims you indicated. Initially, Claim 1 includes all the service lines and data from the original claim; the newly created claims have no associated data.
If there are more than 10 service lines on the original claim, SCE paginates the claim display. SCE also offers a limited search function to assist in identifying service lines to move.
Each claim line displays a check box so you can select the claim line for movement into one of the new claims. Along with the individual check boxes, SCE displays a single “global” check box at the top of the claim line list that automatically selects all claim lines.
Once you select one or more claim lines, SCE displays the number of claim lines to be moved on the Move claims lines button in the top right corner of the screen.
When you click Move claim lines, SCE displays a modal prompting you to specify to which newly created claim the selected claim lines are to be moved. Once you enter the claim number and click Submit, the selected claim lines will be moved to the specified claim.
Within each claim you also have the option of reordering claim lines by dragging and dropping them via the vertical double ellipsis on the left of each claim line.
When you move claim lines to a new claim, SCE displays the Split reason dropdown and requires you to choose a reason for the claim split. You may also enter freeform notes in the Split notes field, if needed.Splitting claims with COB information
When manually splitting claims that contain COB information reported at the header level, all newly created split claims will display a Configure COB button that allows the user to split and configure COB amounts and units for the newly created claims.
If multiple payers are reported at the header level on a claim that has been selected for splitting, each payer is listed on a grid under the configure COB Details label. By clicking on the corresponding expansion icon, you may view the payment information associated to each payer. If there are any adjustments reported, they are displayed separately for each payer under the payment info tab. COB header level amounts and units will be copied and displayed on the first newly created split claim.
For the remainder of the newly created claims, the COB payment information for all the payers is initially displayed as blank. You must split the COB amounts and units across all the newly created claims.
Note: The remaining amounts and units are displayed beside each of the amounts and units and are automatically updated as you make changes to the new claims. If the value of the remaining amounts and units is not zero, you can submit the COB information, but SCE will display a validation error on the main screen indicating the aggregate amounts do not equal the original amount.
If the header-level COB information is not configured in the new claims, SCE will display a validation error. If you wish to indicate that there is no COB paid information for any payer, a value of zero must be entered.Reversing a split claim
When a claim is manually or systematically split, the claim status is set to Resolved-Split. When the Actions menu for a claim with a Resolved-Split status is expanded, the Reverse split option is displayed.
Reversing a claim split updates the status on the new claims created by the split as well as the status of the original claim to Resolved-Cancelled or Resolved-Voided. A new claim with all the original lines is created and sent for processing.
It is important to note that if the original claim was split by the system, the claim will not be split again as it is processed.Manually splitting claim lines
To split a claim line, select the Split claim line option from the Actions menu for any claim assigned to you.
Smart Claims Engine displays the Split claim line slot; all the service lines on the claim are listed. Each claim line provides a vertical ellipsis on the right. Clicking the ellipsis displays the Split option; click this option to proceed with splitting the selected claim line.
When you select Split, a modal appears. The original claim line is displayed at the top in review mode. Underneath, two new claim lines are displayed by default.
The new claim line numbers correspond with the original claim line number, but are followed by .1M and .2M, with the “M” indicating a manual split. Clicking + Split line generates additional new claim lines.
When you split a claim line, the billed amount and units are copied from the original line onto the first new line, while the subsequent new line billed amount and units will be populated with zeroes. The dates, billed amounts, and billed units on the all new claim lines can be edited, but the procedure code is not editable.
Note: when splitting claim lines, SCE does not allow the Service from and Service to dates to overlap; therefore, claim lines with a single date of service may not be split.
On each new claim line, to the right of the billed amount and the units fields, are “left” fields which indicate how many dollars and how many units from the original claim line still need to be accounted for on the new claim lines. These will automatically update based on your configuration of the new claim lines.
SCE prohibits the presence of less than two new claim lines. If you add additional new claim lines, the trash can icon is displayed, allowing you to delete additional claim lines within the SCE limit.
Once you have populated the dates, billed amount, and units for the new claim lines, click Submit to finalize the split.
Note: once a claim line has been split, it cannot be re-split. Additionally, newly created lines are not eligible to be split.
Once you submit the split, the new lines display a status of “New” and the original claim line displays a “Cancelled” status.
Note: you can split claim lines during the claim split process by clicking the vertical ellipsis on the right of the claim line and following the steps outlined above. You may move a newly created claim line to another claim during the claim split process, but the original claim line may not be moved.Splitting claim lines with COB information
When splitting a claim line, if the original line includes COB information, the COB information must be distributed across the newly created claim lines to ensure you have accounted for all COB amounts and units.
Each of the new claim lines displays an expandable grid for the COB information. Clicking on the expansion icon displays the COB information for the claim line, including the number of payers reported for the claim line. If multiple payers are displayed, each payer can be further expanded to view its specific COB information.
The first split claim line created displays all the COB information associated with the original claim line. The COB fields for the rest of the split claim lines remain blank until you manually distribute the amounts and units.
SCE tracks and validates the amounts on the all new claim lines against those on the original claim lines on a payer-by-payer basis to ensure amounts and units balance and will display error messaging as required.