How do I revise information on a paid or denied claim?

If you need to make changes to a claim that has already been paid or denied, you can revise the claim and resend it to the payor through the clearinghouse from AlayaCare. If you have already resent the claim from the clearinghouse, you can also revise the claim in AlayaCare so that it matches the record in the clearinghouse.

You can use this option for open claims with a status of paid or denied and an internal control number (adjudication number). If a paid or denied claim does not have an internal control number, you will need to enter it manually to revise the claim. 

To begin, select the revise button from the claim details screen.

If you have already edited the claim in the clearinghouse, select revise claim to reconcile with clearinghouse. If you wish to revise the claim and then resend it to the clearinghouse, select revise claim in AlayaCare and resend to clearinghouse.

Next, edit the bill codes, amount billed, and units sent for any of the service lines on the claim. If you are updating a claim with changes to the visit or payor information, you can leave this fields as they are and proceed to select revise and resend or revise and reconcile.

You will need to scroll to see the billed and units sent fields.

If you change the units sent, you may receive the following warning: changing units sent on the claim could result in bank time being lost as the entered units are different to those calculated on the claim.

When you have finished, select revise and reconcile or revise and resend.

The changes you made will be immediately reflected on the claim details screen. When revising a claim, the original sales transaction for each service line will be voided along with the original invoice. The revised claim will contain a new sales transaction for each service line, and each service line will have a new invoice. All other transactions linked to the service line will be reversed on the original invoice. Any previous payments, clawbacks and cancel cash receipts made will be recreated over to the new invoice.

 If you are resending the revised claim to the clearinghouse, the status will be updated to prepared.

When you next select send 837 for the funder, the revised claim will be resubmitted.