Assessment Responses

Some eClaims Destinations  are able to send electronic assessment responses.  These responses indicate (per line) what will be paid and what was rejected.  If any of the lines in an eClaims batch were rejected or short paid you will be notified with a message  similar to the following:

Click on the View affected button to see further details.  The following tab will be displayed:

Notice that the medical aid in the above example will pay amounts that are lower than the amounts charged.  When this happens Panacea will show the Transfer short paid button.  If you click this button Panacea will transfer responsibility for payment on the unpaid portion to the Person Responsible .  i.e. the difference between the amount in the Charge column and the Assessed column will be transferred to the Person Responsible .  This unpaid portion will be displayed clearly on the Person Responsible's  next statement so that they know exactly how much they must pay in.

In the above example the eClaims Destination has short paid each line.  However, in some cases they will reject the eClaim altogether.  When this happens you can choose to correct the eClaim (if it was rejected due to an error).  Right-click on the eClaim for a context menu that will provide the functionality needed for this.  See Switch Responses  for details on correcting and resending eClaims using the context menu.