Claim Level Rejection

The SPE Pack for Healthcare Payer allows invalid claims to be rejected, and valid claims to be processed. Validation is run on the document level (claim) for the 5010 837 Claims Transactions.

Claim Level Rejection allows a transaction not to be rejected on the basis of one bad claim. Claim Level Rejection places a bad claim, or claims, in a separate transaction, while leaving good claims in the original transaction.

Claim Level Rejection is not available for the Post Adjudicated Claims Data Reporting (PACDR) 837 transactions.

Claim Level Rejection rejects only those claims in error when it can absolutely be determined that the error is due to the claim in question. Many X12 or HIPAA compliance errors can force the entire transaction to be rejected. For example, HIPAA type 1 and type 2 structure errors are nonrecoverable errors which cause the entire transaction to be rejected. A Claim Level Rejection is not possible for these nonrecoverable errors.