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          Claim Adjustment

          Claim Adjustment

          To revert a claim already processed by a third-party system, you can adjust a claim. For example, if a duplicate claim record exists, the claim is adjusted as Claim Reversal to make sure that the financial numbers are accurate.

          Here are the possible adjustment types:

          • Claim Reversal: To adjust an approved manual claim. When the adjustment is done, the system creates a copy of the original claim with the record type as Reversal. The status of the original claim is set to Adjusted. Both the claims (original and copy) can't be further adjusted and aren’t considered in any TPM calculations. The claim reversal must be approved before it’s communicated to a third-party system.
            Claim reversal
          • Claim Splitting: To adjust an open and partially allocated interfaced claim. The balance amount of the claim can’t be negative and the claim amount must be bigger than the balance amount. When the adjustment is done, the system creates a copy of the original claim with the same record type, which can be further adjusted.

            The claim amount of the original claim is set to the claim tactic amount, so that the balance is zero. The claim amount of the new claim is set to the remaining balance of the original claim. For example, you have a claim for 20,000. After you link a tactic with a payout amount as 5000 to the claim, adjust the claim. The amount of the original claim is adjusted to 5000, and a claim is created with 15,000 as the amount.

            Claim splitting
          • Claim Replacement: To adjust an approved interfaced claim. Typically, you use this adjustment type if you linked an incorrect tactic to a claim. When the adjustment is done, the system creates a copy of the original claim with the same record type. You can add the correct tactics to the created copy of the claim.

            The status of the original claim is set to Adjusted. The claim can’t be further adjusted and isn’t considered in any CG Cloud TPM calculations. However, the deduction replacement is considered for TPM calculations, and can be edited for resolution.

            Claim reversal
          • Adjust Claims
            To revert a claim already processed by a third-party system, adjust the claim.
           
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