Roll Back and Resubmit Claims (Billing Archive)

Before a claim can be rolled back and resubmitted, the reason for the rejection must be identified.

1. Navigate to the Select a File Submission screen (Billing > Submitted).

2. Use the filters to locate rejected claims.

3. Click Search.

   

4. Click the file name to view the file in the Billing File screen.

Once a rejected claim has been found, ConnectCenter can be used to understand the reason why it was rejected and the steps that need to be completed to make sure that the claim is fixed and able to be correctly submitted. Be sure to bookmark ConnectCenter for use with Billing.

1. In a new tab, use the link provided by your Sandata CSM with your credentials to access ConnectCenter.

   

2. Use the filters to locate the claim by date or claim name. You can also click the Incomplete, Rejected or Denied Claims buttons from the menu.

   

3. Click on the rejected claim to see any problems or reasons for rejection.

   

4. The claim is opened in a new window that shows the claim’s status. In this window, you can see any problems with the claim, and what needs to be done to fix it. In this example, the claim is missing the Payer’s City.

   

   See the table below for the most common rejection messages and how to resolve them:

   Rejection Message	How to Resolve It
   Payer ID in claim does not match a Payer in EVV Visit Data	Confirm that the Payer ID on the visit is correct.
   Provider IDs in claim do not match ProviderIDs in EVV Visit Data	Confirm that the Provider IDs on the visit are correct.
   Member IDs in claim do not match Member IDs in EVV Visit Data	Confirm that the Member IDs on the visit are correct.
   Payer ID, Provider IDs, Member IDs combination does not match EVV Visit Data	Confirm that the Payer ID, Provider IDs, and Member IDs on the visit are correct.
   Procedure Code and Modifiers do not match EVV Visit Data	Confirm that the Procedure Code and any Modifiers on the visit are correct.
   Service Dates in Claim do not fall within Service Dates in EVV Data	Confirm that the visit dates are correct.
   Billed EVV Units in Claim exceeds Total Units in EVV Data	Confirm that the Billed EVV Units on the visit are correct and have not exceeded the authorization.

5. Once the issue is fixed, the claim can be resubmitted.

Return to your tab with Sandata EVV with Billing and Scheduling claim open or re-open EVV with Billing and Scheduling.

1. Navigate to the Submitted screen (Billing > Submitted).

2. Search for submitted billing files.

3. Click the filename to open the submitted file.

   

4. Click Rollback.

   

   Rolling back the billing file releases the unpaid invoices (in Bill Sent status) and allows them to be used again for a new billing file. Rolled back invoices are put back to Billable status. Once the invoice has been rolled back, it can be fixed.

5. Fix the claim using the information from ConnectCenter.

To resubmit the claim:

1. Navigate to the Submit Invoices screen (Billing > Submit Invoices).

2. Select the payer in the Payer field to be able to submit invoices. Invoices can only be created for one payer at a time.

3. Search for visits that are billable.

4. Click Submit Invoice(s).

   

   The billing file is electronically sent to the payer. Download and Save the file as needed.

5. Enter the provider ID if prompted.

6. Click OK.

   

7. Click OK to download the file if needed.

   

   The claim is now correctly resubmitted and ready for approval.

Once the claim has been fixed, resubmitted, and accepted, ConnectCenter can be used to review the claim’s remittance status.

1. In a new tab, use the link provided by your Sandata CSM with your credentials to access ConnectCenter.

   

2. Use the filters to locate the claim by date or claim name. You can also click the Good Standing Claims section of the pie chart.

   

3. Click on the accepted claim to view the claim details.

   

4. Review the claim’s remittance details and verify the payment amount.

   

Users have been pre-enrolled in ConnectCenter by Sandata and should receive an e-mail, with their username and password. For Security purposes it is recommended that you change your password to something appropriate and personalized for you.

To reset your ConnectCenter password:

1. Use the URL provided to you to open ConnectCenter.

2. Click Forgot Password?

   

3. Enter your User ID. If you do not know your User ID, refer to the e-mail you received from Sandata. Click Continue.

   

4. Answer your security question. Click Continue.

   

5. You are sent an e-mail with a temporary password and instructions on how to reset your password.