Episodic Claims Void and Replacement

About Voiding and Replacing Episodic Claims

Important: The following information applies only to the Episodic (PPS and EPS) claims. To generate voids and replacements for non-Episodic claims, use the Recalculate Claims utility in Administration>Maintenance.

Netsmart Homecare generates voids to create Accounts Receivable (AR) transaction to reverse the original claim and send the void to a payer as a notice that the original claim should be voided from the payer's system. However, CMS does not require a traditional void for Final claims. Instead, CMS requires only a replacement claim with a bill type of 3x7 (3x9 for EPS) and condition codes to explain the need for the replacement.

Therefore, for Final claims, you can choose what to generate – a void and a replacement, or only a replacement (applicable to PPS only) so that you can avoid creating unnecessary adjustments to AR. Once the Final claim has been replaced only, no void/replace can be done to the original Final claim.

When should I generate only a replacement?

Generate only a replacement claim for the Final claims (not RAP) to report changes that do not require claim recalculation, such as additional services or supplies. If you choose to generate only a replacement claim, the application assumes there is no financial change and makes no changes to AR. In this case, the generated replacement claim will have a zero amount in both the Standard Net and Actual Net Amount fields but will show changes only to the gross charge amount.
Note: This option does not apply to EPS.

When should I generate a void and a replacement?

Generate a void and replacement when it is due to financial changes. A void claim cancels the episode, so although you need it for the appropriate AR adjustment within the application, you do not want to send it to the payer. To exclude these types of claims from electronic transmission, use the Special Handling field in Administration>Financial>Insurance Codes>EMC.

After Generating

After generating voids/replacements, claims are assigned to the next available cycle as defined for the pay source. Use the Annotate Claims function to add the appropriate condition codes, remarks, and document control numbers. For PPS, the application assigns the claim type of 3x8 to the voids, 3x7—to the Final replacement claims, and 322—for the RAP replacement claims. For EPS, the claim type is also 3x8 for the voids, 3x9—for the Final replacement claims, and 3x2—for the Interim replacement claims (x – this digit depends on the print variation selected). 

Episodic Claims Void and Replace Window

Path: Transactions>General>Episodic Claims Void and Replace

With the Episodic Claims Void and Replace window, you can generate voids and replacements for closed Episodic claims (PPS and EPS) when the level of care is changed or additional services are added to the closed claims. For more information about voiding and replacing claims, see About Voiding and Replacing Episodic Claims and Voiding and Replacing Closed Episodic Claims.