Claim Processing Blackout

Define a date range for any combination of funding source, provider, member, and authorization which will prevent the approval of all claims during that date range.

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1. In the Add/Edit/Delete field, select whether to create a new record, edit an existing record, or remove a record from the system.
2. In the Blackout Record field, select the record to edit or delete.
3. If the blackout pertains to a client, specify the individual in the Client field.
4. If the blackout pertains to a provider, specify which one in the Provider field.
5. If the blackout pertains to a funding source, specify which one in the Funding Source field.
6. In the Authorization field, select the authorization. The values available in this field are determined by the selections made in the Client, Provider and Funding Source fields.
7. In the Blackout Start and End Date fields, select the first and last dates for the blackout period. 
    The Blackout Start Date cannot be changed to a date that is earlier than the originally filed date.
8. In the Authorization Blackout Dates field, select the individual dates to include in the blackout. If left blank, all dates will be included.
9. In the Blackout Reason field, select the reason for the blackout.
10. In the Claim Status field, select whether services submitted during the blackout period should be denied or marked as pending.
11. In the Claim Status Reason field, select the reason for the claim status.
12. In the Comments field, enter any comments related to the blackout.
13. The Previously Denied Services For Retro-Adjudication field displays any services that were denied because of the blackout restrictions. Services with an existing retro record will not appear.
14. In the Adjustment Code field, select the code.
15. Click Submit.