Problem Statement

Claims that have already adjudicated often need to be reprocessed when another department identifies a problem, and these requests arrive informally and have to be worked one claim at a time. A request comes in by email with a spreadsheet of claims, and someone has to open each claim in Facets, navigate to the right processing path, apply the requested override, note it, and finalize it. The instructions vary request to request, so the work is manual and repetitive, and a backlog of adjustment requests means claims stay incorrect until someone gets to them.

Automation Solution

This automation reads an emailed adjustment-request spreadsheet, opens each listed claim in Facets, applies the requested medical or hospital reprocessing with the appropriate overrides and notes, and finalizes the claim.