>A very common practice. I work in the healthcare industry where this a
> required process. In healthcare there are sophisticated 'work-flows' that
> are created to allow claims folks to review, modify, approve, pend,
> reject,
> etc. These changes are normally done in the backend system where the
> transactions are loaded. Occaisionally mods are made in an external
> application (like a scanned/ocr claim might be reviewed and corrected
> prior
> to load).
>
> However, and I cannot stress this enough, never let them near the EDI
> data.
> That would be a very bad idea.
There is a world of difference between pending a claim and editing the data
to get it into the adjudication system.. which may/will then pend one or
more claims.
I know for a fact that Medicare claims data cannot be touched at all..
either it passes the edits and makes it into the adjudication system, or it
fails. If it fails compliance edits, the entire transaction set is rejected.
An individual claim is "rejected" only when it passes compliance edits but
fails an application edit (e.g "invalid HIC number")
There's also a world of difference between Medicare and "Joe's Purchase
Order for fifty bucks worth of widgets."
Then there's also the Real World, where deficient/incomplete purchase orders
are often 'helpfully corrected' by the seller, but so much as a misplaced
comma on an invoice means immediate rejection by the buyer.
MCM
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