Problem Statement

Charges held by edits sit unbilled until staff manually resolve the flagged issue. When an account has Medicare set as primary but real-time eligibility (RTE) shows Medicare is not the primary payer, billing in that order produces a denial or incorrect payment and creates Medicare Secondary Payer compliance exposure, so the filing order must be corrected before the claim goes out. While these accounts wait, they accumulate in Discharged Not Final Billed (DNFB), lengthening time-to-cash and risking revenue leakage on services that were performed but never cleanly billed.

Automation Solution

This automation corrects the payer filing order and resubmits claims for accounts where Medicare is set as primary but RTE indicates Medicare is not the primary payer.