1. How do I correct or resubmit a rejected claim?
- Open the rejected claim.
- Review the rejection reason displayed.
- Correct the data (e.g., ICD-10 code, dependent code, authorization number).
- Save changes and click Resubmit Claim.
Attach the rejection screenshot when logging a query if you need assistance. For more support on understanding rejection reasons or codes, provide patient details in your query. (Becoming familiar with common terms comes with practice; we can assist via training if needed).
2. Why was my claim rejected for “invalid code” or “no authorisation”?
These rejections occur when:
- Incorrect ICD-10 or procedure codes are used
- Authorization was not obtained or expired
- There is a mismatch between diagnosis and procedure
Check the medical aid rules or use our Real-Time Verification tool before resubmitting.
3. How can I check real‑time benefits or eligibility before seeing a patient?
Use the Eligibility/Benefits Checker in the patient file.
- You can verify:
- Benefit limits
- Required authorizations
- Co-payment expectations
This helps prevent rejections later. However, active medical aid membership is only confirmed after billing – if rejected, check the medical aid’s website or call them for confirmation. For exact benefit amounts, contact the medical aid directly, as the checker may only indicate availability vaguely (e.g., “they have benefits”).
4. How do I update or add a new patient’s medical aid details?
- Go to Patient File → Medical Aid Details.
- Edit or add the scheme, plan, dependant code, and membership number.
- Save and validate the membership using the Medical Aid Import button.
Accurate info reduces claim rejections. (If you encounter errors during validation or invoice generation, log a query with details).
5. What patient information is required to avoid claim rejections?
Ensure:
- Correct ID/passport number
- Accurate dependant code
- Full member name as on the medical aid
- Valid medical aid number
- Correct ICD-10 & procedure codes and referring doctor details
- Authorisation number
Missing details commonly cause claim rejections.