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. At the top of the form a read-only Payer decision panel shows what the payer decided on the claim — the decision status, the asked / approved / deducted amounts with their reason codes, the disputed amount, the payer's Remark, and any Rejection codes in red. When the workflow has no payer decision recorded, the panel says so.

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 — auto-filled with the disputed amount (the claim amount the payer asked minus the amount approved) and read-only when the reason is partial payment and the payer's response carried the amounts. For the other two reason codes, and when no amount could be derived, the field stays editable.
• 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: Normally none — for partial payment the form fills the Amount itself with the disputed amount (the portion the payer did not pay) and locks it, so it cannot be mistyped. The amount is only sent to the payer when the reason is partialpayment. If the payer's response carried no amounts, the field stays editable and you can type the figure.

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