NHCX Reprocess Claim

Overview

When a claim is rejected, disputed, or only partially paid, you can ask the payer to reprocess it. The reprocess flow first searches for the claim to confirm its current status, then submits a reprocess request with a reason, the disputed amount, and supporting documents.

Where to find it

Open the patient's NHCX page, find the workflow, and choose Reprocess.

Step 1 — Search

The Search step confirms the claim exists and fetches its current status.

1. Enter the Claim Number (pre-filled from the workflow).
2. Add a Description if needed.
3. Submit.

Step 2 — Reprocess

The Reprocess step submits the request. Fill:

• Reason Code — why the claim is being reprocessed:
  • Reprocess request due to claim rejected by payer (claimrejected)
  • Rejection is disputed — additional evidence provided (rejectiondisputed)
  • Reprocess request due to partial payment by payer (partialpayment)
• Amount — the disputed/remaining amount (for partial payment).
• Supporting Document — a PDF or JSON document providing evidence for the reprocess.
• Appeal Justification — free-text justification.

The claim number and intimation number are carried from the workflow.

Common Issues

• Supporting document required — the reprocess request needs a supporting document attached.
• Wrong reason code — choose partialpayment only when the payer has made a partial payment; use claimrejected or rejectiondisputed otherwise.

FAQ

Q: When should I use reprocess vs cancel? A: Cancel is for withdrawing a pre-authorization before/around treatment. Reprocess is for getting a payer to re-look at an already-submitted claim (rejected, disputed, or underpaid).

Q: What amount do I enter for partial payment? A: Enter the amount still in dispute (the portion the payer did not pay). The amount is only sent when the reason is partialpayment.

Q: What format should the supporting document be? A: PDF is typical. JSON files are sent as FHIR JSON.