Switching: Claim Administration

The user manual is currently being updated with new features. An updated version will be available shortly. We thank you for your patience.

If any mistakes were made on a Claim, the user has the ability to amend the error by doing a Reversal of the claim, Redo the Invoice and Resubmit the claim. The Claim/Switch History is used to view all the claims and their statuses that have been sent through to the Medical Aid. The user will view the Claim Response from the Switch Screen too. The Practice should review Switch History and Claim Responses to ensure that all claims are processed successfully every day.

• The contents of this user manual will consist of the following information:
• EDI Response
• Reprocess Switch History
• EDI Reverse
• EDI Redo

• 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.
  

• Claim/Switch History is used to view all the claims and their statuses that have been sent through to the Medical Aid.
  
• It is very IMPORTANT for the Practice to go through te Switch History every day to make sure all claims are processed successfully. 

How and Where to view the Switch History:

• On the Diary screen, click on Admin

• Click on Switch History on the Task Bar
• The Switch History screen will open with all the claims that was sent through for that day

• You can filter Accounts by Date, Status or Medical Aid
  
• Click on Search when you've selected your filters
• Every status has a different colour

TAKE NOTE: Meaning for different EDI Response Status

• If you click on a Claim notice the Options on the bottom of the Page are not greyed out anymore. You can perform actions on a claim from this screen:
• View Response: you can view the EDI response of the claim here. This is the response you get back from the Medical Aid after the claim was submitted to see if it was processed successfully etc. 
• Account Details: You can view or edit the Invoice from the account details screen
• Debtor Edit: You can edit the debtor if information like an ID number or dependant code needs to change if the claim was maybe rejected due to an incorrect ID number or Date of Birth
• Switch All: this function will switch all claims to the Medical Aid that was not sent through yet. You can filter your "To Send" claims and then switch all with this function.

TAKE NOTE: Once a claim that was rejected is resolved and resubmitted to the Medical Aid, you can select the Invoice and right-click in the Resolved column and mark the claim as Resolved.

EDI Response 

The EDI Response is the Medical Aid's response in which the user can see whether the claim was approved or rejected.

• Only rejected invoice claims can be reversed, thus the user should select the rejected claim.
  

• The user should click the View Response button after selecting the rejected invoice claim to view the response from the medical aid.
  

• The Switch Details screen will open.

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

Reprocess Switch History

Reprocess Switch History refers to the reprocessing of a previously submitted claim.

• The user will be able to reprocess the Switch History for the Switch Details screen.
  

• Click on the Reprocess Switch History button to instantly reprocess the claim. 

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

EDI Reverse

If any changes were made to the claim, EDI Reversal is utilised to reverse the claim.

• The user will be able to reverse a claim from the Switch History screen
  

• Click the on Reverse button to reverse the claim.

Please Note: The user will stay on the Switch Details screen while the claim is being reversed.

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

EDI Redo

When a user wants to redo an invoice, one can utilise the Redo feature, which will generate an automatic Credit Note and populate the same Invoice as the original invoice, allowing the user to make changes before posting it.

• Click on the Invoice Details tab at the top left corner.

• The Invoice Details screen will open.

• Click on the Redo button if the user wishes to redo the invoice. 

• The Create Credit Note pop-up will appear, prompting the user to type a reason for the EDI Redo.

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

• 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: 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.

• Click on the Navigation Wheel.

• The Navigation Wheel will open.

• Click on the Diary segment.

• The Diary screen will open.