When to Resend? When to Resubmit?

A claim item with a status of:

RESEND(ING) or NEW (effectively the same) is

• A single transaction item requesting payment - this cannot succeed if the item is already present on the MOH system payments database.

NB: If the item IS already on the MOH  system (paid or unpaid), the request will result in a 160 error. (See MOH error table below)

A claim item with a status of:

RESUBMIT(TING) is

• Two transaction requests to 1) reverse out and 2) re-process a prior payment i.e.
  1. Credit a prior payment (from MOH ) for this item
  2. Re-process the item and pay it again

NB: If the item is NOT already on the MOH Payment system, both requests will fail,  the credit because there is nothing to credit and the re-process because there is nothing in the MOH system to re-process, the reply file shows a 404 error (re-submission but no paid original). 

If the claim item is on the MOH payment system but in an unpaid state, a 402 error is returned indicating that the credit (only) has failed (because there is no payment to credit).  However in this case, the re-process will go ahead.  If there are no other errors agains the resubmission, then this re-process has succeeded.  

MOH Sector Services Claiming Errors

Examples of Use of Resent/Resubmit to Fix Errors

MOH Error	Dispensing	Resend / Resubmit	Comment
160 (only)	Repeat or /1, /0	Resubmit	Check last claim (F5 Claims Log). Item was probably Resent in error. Resubmit now
404	Repeat or /1, /0	Resend	Check last claim (F5 Claims Log). Item was probably Resubmitted in error, RESEND now
597	Repeat	Resubmit /1 & Resend repeat(s)	/1 info in MOH Payments system must be updated by resubmitting a corrected /1. (Check /1 Var Rpts in Toniq). Once Total Qty on /1 is correct (in the  MOH Payment system), the repeats will pay when Resent
152	Repeat	Fix /1 and Resend Repeat(s)	/1 has not been paid, find out why (!) then (Re)send OR Resubmit /1 depending on the reason. Once /1 is correct, Resend repeat(s)