RCM & insurance

Preserve performed charges and their correction chain

Follow a clinical event to charge capture, claim lines and later amendments.

Current source · source reviewed · 7 min read

Before you begin

An accurately recorded performed clinical event.
Correct service mapping, units and performed date/time.

1. Confirm the performed event

Review the original clinical event and its actual performed time. Coverage uncertainty must not erase the record that care was performed.

2. Inspect the original charge

In claim details, inspect Original charge capture and its linkage to the clinical event. Check whether performed time is missing, capture is late or the charge amends an earlier capture.

3. Compare financial facts separately

Review contractual pricing, benefits/share, authorization match, tax and payer adjudication as separate facts. A local invoice line and a captured service are related but not identical.

4. Correct through an amendment

Retain the original capture and use an evidenced amendment/correction chain. Follow the original and amended capture into the appropriate claim rather than rewriting historical submitted facts.

One encounter can produce multiple claims

Added services can be captured after the original claim. Preserve the episode identifier and distinguish a follow-on claim from a correction of the original.

Financial hold is not missing care

Unresolved tariff or eligibility can hold financial processing while clinical event capture remains preserved. Escalate the financial mapping rather than deleting or hiding the performed event.

Troubleshooting

A claim line has no linked capture

Open the recorded reason and request revenue-integrity review. Check the clinical event, service mapping and performed-time attestation before rebuilding the claim.

Source evidence

References are pinned to the private MANSOQ source repository. Repository access is required to open these links.