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Related claims and episodes

Updated on December 15, 2021

As a healthcare processing system, for each claim the system automatically associates related claims, at the time of execution, based on the logic in the module. For example, duplicate related claims are assigned in the Business audits module (SBA) with the dupe check logic.

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The associated claims show in the Related claim section on the UI, with claims associated with each other for different reasons. Different claims can be associated with each other because of the following reasons:

  1. Interim Bills
  2. Duplicate Claims
  3. Adjustments
  4. Same Authorizations
  5. Readmissions
  6. Predetermination
  7. Split Claims

To enable the display of the related claims into the UX, the module Episode processing (SEP) is required to be added to the orchestration. This should be implemented prior to the Event review module (SER). This module sets the final related claims list for review.

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