Problem Statement

Claim edits create manual rework before a claim can go out the door, and edits left unresolved either delay submission or, if missed, produce avoidable denials that erode the clean claim rate and push out cash collection. NDC and diagnosis-code rejections are a coding edit, not something follow-up staff can fix: the claim can't bill until a coder corrects the offending code, so the account first has to be routed to the right team, then picked back up once they've made the correction. That handoff is where these stall, sitting between the rejection and the rebill while no one owns the next step, and the claim ages unbilled the whole time.

Automation Solution

This automation reviews the claim rejection workqueue for NDC and diagnosis-code rejections, routes each to the appropriate team for correction, then reverses the original billing and rebills the claim in Epic once the codes are updated.