Stream: implementers
Topic: Denied claim items/services
Katerina Nikolova (Jun 02 2021 at 12:17):
Hello!
I have a couple of questions regarding denied/reversed item or services on ClaimResponse resources
Is there a way to indicate (at a line item level) whether an item or service was denied and the reason behind that decision - different processing policies, etc.
The claim itself can be an original but different line items can be denied.
I am thinking of two options:
- Creating ClaimResponse for each line item and using outcome and disposition elements to indicate the status of the item
- Creating a ClaimResponse for all of the items and using the item.adjudication.reasonCode to indicate why that particular item/service was denied.
Thank you!
John Silva (Jun 02 2021 at 12:50):
@Katerina Nikolova - you might get some input from the folks on the #Da Vinci PAS channel since their efforts deal with the Claim/ClaimResponse workflow.
Last updated: Apr 12 2022 at 19:14 UTC
