Same day Double service #50
Claim adjudication requires extreme thoroughness.
Therefore, it will be necessary for the system to manage according to various processing criteria and limits.
At the moment, the main insured has a pending batch which has not been processed. We decide to add a new complimentary batch to it.
For the purpose of the presentation, we will use extended health related services.
We determine the date and the required service.
The first claim for acupuncture treatment, dated on January 5th, to the amount of $30, is authorized.
A second acupuncture treatment claim, for the same day, is refused since the service is already being performed for that day, and the system had been notified, at the configuration level, to accept only one claim per day for such a service.
Once the date has been changed, we are able to ask for this claim to be re-processed.
Once we have closed our batch, we are able to view the overall generic information about our claim.
At any given time, it is possible to access any item from a batch by simply double-clicking on the said item. Once this item has been accessed, change can be made according to need as often and as long as this batch has not been paid.
When leaving this batch, one accesses a list of pending batches for the main insured. Two batches can be noticed, the first one, batch 23830, corresponds to the previous one before the creation of the current batch.
It is possible to access either one by simply clicking on one or the other to access the list of items associated with this batch.