Process Failed Reversal

PDX Third Party Exceptions

Process Failed Reversal

If you receive a Third Party Exception task that was created as a result of a failed claim reversal during another process (for example, a credit return or billing change), the system displays the following message: This prescription has been cancelled or credit returned. You may need to phone the third party to perform a  reversal. Use Claim Override to update the claim prior to complete. Once this task is completed, this prescription will be removed from workflow.

To process a Third Party Exception task for a failed reversal:

1.    Select Reverse.

2.    If the reversal is successful, go to step 7.

Notes:

·       If the number of days in the Reversal Days field on the Insurance Plan Billing window has elapsed since the prescription was filled, the system prompts Cannot Reverse Claim. Reversal is only allowed within [#] days. This claim was filled [#] days ago. Go to step 3.

·       If the reversal fails again, the system prompts Reversal transmission failed. You may need to phone the third party to perform a manual reversal. Complete the task when finished. Go to step 2.

3.    Contact the third party, if needed, to manually reverse the claim.

4.    Select Claim Override.

5.    Enter the information as needed on the Claim Override window and select Save.

For more information, see Manual Claim Override window.

6.    Select Close to return to the Third Party Exception window.

7.    Select Complete to complete the task.