Switching: Claim Administration

Please revisit this page on 31 May 2022 to see the latest version of the User Manual. Thank you for your patience.

• The contents of this user manual will consist of the following information:
• Medical Aid Rejection 
• Reversal Submitted (unconfirmed)
• Reversed

• Log in to the GoodX Web App using your GoodX 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 Communication segment.

• The Switch History screen will open.

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

Medical aid rejection 

When a claim is submitted to the medical aid, line items may be rejected for a variety of reasons. The Rejection codes help in the correction of the claim or provide the patient with an explanation as to why they are accountable for this line item.

• Select desired invoice that the user would like to see and view the response of.

• Click on the View Response button to view a detailed response with regards to the specific claim.

• The Switch Details screen will open.

• An explanation will be given for all the information that is dispalyed on the Switch Details screen.
• At the top of the Switch Details screen, the user will see the Debtor's and Patient's personal demographic information.

• Rejection Reasons: A motivation provided by the medical aid as to why the Switch claim has been rejected.

• Rejection - Invalid billing provider: This occurs when the user submits the incorrect billing provider, resulting in the Switch claim being refused. 
• Rejection - The membership is invalid: Switch claims are rejected when the user enters the incorrect medical aid membership number. Other reasons include the claim not being sent through or the account not being active.
• Rejection - Content Failure: The debtor's information is incorrect, resulting in the rejection.
• Warning - 757:The codes on the invoice are not the same as the ones used by the treating provider.
• Warning - Warning possible short payment: When the medical aid hasn't paid the entire outstanding amount for which the medical aid is responsible.
• In the Switch Details section, the user will see the following information:
  

• For more information regarding the Switch Details screen, please refer to the user manual: WA: Switch Response.
  

• Click on the Reprocess Switch History button to update the Switch Details screen.

• Select the drop-down menu next to the Save and Close button for more saving choices.
  

• Save: The user is able to save the changes made to the form without closing the form. 
• Save Lines To New Macro: This allows the user to create a new macro.
• For an extensive explanation of the New Macro 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 Switch History screen.

Reversal Submitted (unconfirmed)

When the medical aid has not responded to the user's reversal request and the user is waiting for a response from the medical aid.

• Select the invoice that was unconfirmed.
• Click on the View Response button to view a detailed response with regards to the specific claim.

• The Switch Details screen will open.

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

Reversed

When a user asks for a claim reversal after it has been denied, and the medical aid responds by reversing the claim.

• Select desired invoice that the user would like to see and view the response of.

• Click on the View Response button at the bottom of the screen.

• The Switch Details screen will open.

• Click on the Reprocess Switch History button to update the Switch Details screen.

• After the user has clicked on the Reprocess Switch History button the  Switch Details screen will refresh and the user will see the updated Medical Aid response.
• Click on the Save and Close button to save the Switch Details screen and close the screen.

• The user will return to the Switch History screen.