Problem Statement

Coverage and benefit details must be confirmed and entered accurately before billing, and doing this manually at volume is slow and error-prone. Replacement Returned and E-Rejected eligibility errors mean the plan on file is invalid or has been superseded, so staff must validate the plan and either update or remove it before the coverage flag will clear. Gaps like these surface later as eligibility denials and avoidable rework.

Automation Solution

This automation identifies Replacement Returned and E-Rejected eligibility errors, validates the plan, updates or removes coverage as needed, and clears the coverage flag.