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ECLIPSE Exception - Some items paid but at least one item fully unpaid

  • Updated

You may have an ECLIPSE claim return with exceptions, where some items have been fully paid but at least one item is completely unpaid (i.e. rejected). This can happen for numerous reasons, such as:

  • You have attempted to claim more than one identical or similar items for the same or similar service dates,
  • You have not noted the treatment site for a surgical item, or
  • There are issues with an assistant item.

Highlight the claim in IMC Claims Control > Exceptions to Review and click the Review Exceptions button.

eclipse_exception_partpaid2.png

  1. Highlight the item in red and assess the messages returned from Medicare and the health fund.
  2. Based on the messaging, determine if you can resubmit the item, or if you are unable to claim for this service.
  3. With the item highlighted, click Remove Item from Claim. The item will then be greyed out.
  4. Click Close and the claim will then move to Awaiting Remittance Advice or Ready to Receipt.
  5. Navigate to the patient's account history and locate the invoice.
    1. Resubmit the item:
      If you would like to resubmit this item, make the appropriate changes (i.e. fix the problem that caused it to be rejected), then highlight the item in the patient's account history and click Resubmit IMC Exceptions.
    2. Credit the account:
      If you are unable to retransmit this to the fund, perform a slow double-click in the Credit column and enter in the fee amount to balance the invoice. When prompted to enter a reason for crediting the account, enter the reason for rejection.