Switching: Claim Administration

Switching is the process that allows the Practice to submit claims directly and in real-time to all major Medical Aid computer systems. In return, the Practice will receive a Switch Response to their request to indicate whether the claim has been approved or rejected. Switch responses assist the Practice with the Claim Administration process.

• Log in to the GoodX Web App with your username and password.
• The Diary screen will open.

• Click on the Navigation Wheel on the Navigation Bar. 

• The Navigation Wheel will open.
  

• Click on the Debtors segment.
  

• The Debtors screen will open.

• For more information regarding how to search for a Debtor and how the Debtor screen works, please refer to the user manual: Debtor Search.
  

• Click on the desired Debtor for whom the user would like to see the Switch Response.
  

• The Debtors sidebar will open.

• Click on the Account Details button.
  

• The Account Details screen of the selected Debtor will open.

• Double Click on the line of the invoice that the user would like to see the Switch Response.

• The Invoice Line menu will open on the Actions tab.

• Click on the Switch Actions button.
  

• The Switch Details screen will open.

• All the fields on the Switch Details screen will be explained below:

• The personal demographic information of the Debtor and Patient for whom the claim is, will appear at the top of the Switch Details screen.

• The following information will appear in the Switch Details section:

• Claim Date: The date (yyyy-mm-dd) and time (hh:mm:ss) when the claim was submitted.
• Ticket #: When a user posts the claim, the system generates a unique number that serves as a reference number for the claim submission.
• Switch Reference: The reference number of the switch that identifies the switch transaction.
• MA Reference: The reference number that the Medical Aid will use when there is any inquiry on the invoice. The MA Reference is the same as the Switch Reference.
• Total MA Claimed: The amount that has been submitted, that the Practice is claiming from the Medical Aid. 
• Total Patient Claimed: The amount the Patient is liable for and is claiming from the Medical Aid.
• Total Submitted (MA + Pat): The total amount that has been submitted as a claim. The total includes both Medical Aid and Patient liable portions of the invoice.
• Total MA approved: The amount that the Medical Aid is going to pay from the claim that was submitted.
• Outstanding: The total amount that is not approved by the Medical Aid to be claimed, and that the Patient is liable for.
• Claimable MA Portion: The maximum amount that the Practice is able to claim for the request and the Medical Aid is willing to pay.
• Switch Status: The current stage of the claim within the Switch process.
• Approved: The claim has been accepted by the Medical Aid and they will be making a payment to the Practice.
• Received: The claim submitted has been successfully delivered to the switch and is being processed.
• Denied: The claim has been rejected for a specific reason, such as the Patient is not covered or the funds have been depleted, and the Patient will be held liable for the payment thereof.
• Submitted by: The person at the Practice who sent the claim to the Medical Aid via the Switch.

• Click on Send Proof of Submission button if the Debtor, Patient, Medical Aid or Practice requires the user to send proof that the claim was submitted.

• The Proof Of Submission screen will open.

Please Note: The Medical Aid and Debtor's email will be filled in automatically when the Proof Of Submission screen opens.

• Complete all the relevant information in the correct fields.
  
  

• An explanation will be given for each field:
• Recipient: The main person to whom the email is addressed and who will be receiving the email.
• cc: Carbon Copy - An exact copy of the email will be sent to the mailing address that is provided.
• bcc: Blind Carbon Copy - An exact copy of the email will be sent to the mailing address that is provided. For privacy and security purposes the email addresses that the email has been sent to will not be visible to the other recipients. 
• Subject: A description to advise the recipient of what the E-mail is regarding.
• Message: All the information that the user would like to send to the recipient. The Message field is a free text field with no character limit.
• Click on the Message field to enter a note to the recipients.
  
  

• Click on the Send button to send the email and return to the Switch Details Screen.
  

• Click on the Close button to return to the Switch Details screen without sending the proof of submission.

• Click on the Reprocess Switch History button.
  

• The information on the Switch Details screen will update.

Please Note: The Switch Details screen will change depending on the Switch Response status. 

• For more information regarding Switch History, please refer to the user manual: WA: Reprocess Switch History.
  
  
• Click on the Reverse button, to reverse the claim if the user made a mistake or needs to add products to the invoice.

• The information on the Switch Details screen will update.

• For more information regarding EDI Reverse, please refer to the user manual: WA: EDI Reverse.

• Click on the Close button to return to the Account Details screen without saving.

• Click on the drop-up menu next to the Save and Close button for more saving options.
  

• Save: The user is able to save the changes made to the form without closing the form. 
• Save Lines To New Macro: Allows the user to create a new macro. 
• For an extensive explanation of this feature please refer to the user manual: Macros (Billing Combinations). 

• Click on the Save and Close button to save the Switch Details screen and close the screen to return to the Account Details screen.

• Once the Claim has been received by the switch it can also be seen on the Switch History screen.
  
  
• Click on the Navigation Wheel on the Navigation Bar. 
  
  



• The Navigation Wheel will open.
  

• Click on the Communications segment.
  
  

• The Switch History screen will open.
  
  

• For more information regarding the Switch History screen please refer to the following user manual : WA: EDI Switch History