Claim Errors: When to Resend or Resubmit

See Claim Error Investigations for tools to find causes of errors.

Quick Info

• Resubmit = when an item has already been paid or credited in a previous claim
• Resend = when an item has not been paid and has errored in your current claim
  • You can view this in the claim history of the prescription.

A claim item with a status of:

• Resend(ing) or New is a single transaction requesting payment.
  • If the item is already on the claiming system (paid or unpaid) the request will result in a 160 error.
• Resubmit(ting) is two transaction requests:
  1. To reverse out (crediting) a prior payment for this item, and
  2. Reprocessing the item and paying it again.
     • If the item is not on the claiming system, both requests will fail (there is nothing to credit or re-process) and the reply will show a 404 error.
     • If the item is on the claiming system but unpaid, a 402 error is returned - only the credit has failed but the re-processing will go ahead.

Claim Errors: How to Resend or Resubmit has practical steps to follow in the Dispensary program.

See also Claiming Process and Claim Error Investigations.

Reviewed: 10/12/2024