Submission Mode - Example

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part of Remittance Processing

Submission Mode allows you to view the Claim at the Submission level vs the Service Line Level when viewing Multiple Service Line Claims. In Submission Mode, Adjudication and Actions are entered on the Submission Level instead of the Service Line Level. Typically, when one does that, the Service Lines will follow their own separate paths.

ForIn example, if I apply Re-Submit to Other individually on Service Lines then you’ll likely have several Claims produce as a result. Even in this mode, Adjudication and Actions will still flow to the Service Lines. Submission Mode is the default view. Use this when needing to adjudicate to submission level and apply actions for entire claim.

Example 1

Multiple Service Line Claim w/o Submission Mode. You will see each line and note that you must Adjudicate and Apply Actions at this level. If Claims are Adjudicated at the Service Line Level one would want the Adjustment Groups & Amounts etc at this level. Service Lines will follow their own paths if you work them Individually Actions wise, meaning Service Lines 1 & 2 could become their own Claims upon balance billing etc.

Example 2

Multiple Service Line Claim with Submission Mode. You will see the Service Lines are not exposed and that Adjudication/Actions could be entered at the Submission Line Level only.

Best Practice for Multiple Service Line Claims.

835’s will post how the funder pays. Claim or Service Line Level. Use Submission Mode to apply Action at the Claim Level if your intent is to send the Claim down whole for Adjudication.
If Paper Remittances and Adjudication are at the Service Line Level, apply Adjustments/Amounts when NOT in Submission Mode. If the intent is to send the Claim down whole for Adjudication, ensure you are in Submission Mode for the Action.