It was analysed that a doctor cannot change a claim using "edit". A new claim request must always be created to correct errors.
Presumably, this is supposed to contribute to less fraud & abuse, but it proves to be inappropriate in practice.
It is suggested that ONE edit should be possible after the claim has been "rejected".
The workflow could be made very practical and include a "state the reason for edit" (this can be selected via dropdown).
It should be visible in the system that a claim is an "original" claim or a "revised" claim. |