Switching: Claim Administration

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

Business Requirement: The Resubmission of a claim is done when there was a rejection on the claim and a correction was done. Before the amended claim can be sent to the medical aid again, the claim needs to be reversed.

• The contents of this User Manual will consist of the following information:
• Claim Reversal.
• Re-submission of a Claim.

• Log in to the GoodX Desktop App with your username and password.
• Double click on the MedDebs module.

• The Debtor Manager screen will appear.

• From the toolbar, click on the Admittance button.

• The Main Member Input screen will appear.

• Search and select the correct debtor, click on the Account button or F9 on the keyboard.

• The Account Query screen will appear.

• Click on the invoice that the user would like to reverse and click on the GoodXSwitch tab.
  

• The GoodXSwitch screen will appear.

• Click on the Reverse Claim button to reverse the selected invoice claim.

• A Confirmation screen will appear to confirm whether the user wants to reverse the claim or not.

• Click on the Cancel button to cancel the reversal.

• Click on the Send Now button to proceed with the reversal.

Please Note: Claim reversals can also be done from the Claim History screen, for more information, please refer to the user manual: Claim History.

Re-submission of a Claim

• Click on the invoice that you want to resubmit 

• Click on the Resubmit button.

• A Confirmation screen will appear.

• Click on the Cancel button to exit without resubmitting.

• Click on the Send Later button to send the claim at a later stage. 

• Click on the Send Now button to resubmit the claim.

• The EDI claim response screen will appear.

Please Note: When you send a claim through, remember to make sure that it went through  successfully and that there are no  rejections . If there are rejections, please pay attention to the rejections.

• Normally if there was a rejection it will show right at the top MFRej-Medical Aid Rejection and at the bottom right it will also show you the Rejection reason.

• If you have submitted more than one item, some items may be approved and others rejected. To easily view this, double click on the section of the diagram below that you would like to enquire about.

• If there is a rejection it will also show it as patient liable.

• Click on the Done button.

Please Note: The EDI Claim History will provide you with a list of all the claims that have been or can be submitted electronically.

• From the Debtor Manager screen.

• From the menubar, click on EDI/Batch Management.

• From the submenu, select GoodXSwitch, from submenu 2, select Claim History.

• The GoodXSwitch Claim History screen will appear.

• Click on the Fetch & Refresh data button in the top left corner to Fetch new feedback from the medical aid and refresh.

• Filter between dates:

• Filter on status. 

• Send/Resend all claims according to your filter  

• Do a Patient Validation, View  Response, and Reverse claims

• Click on the OK button to exit the GoodXSwitch Claim History screen.