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Health & Troubleshooting

Validations​

Claims are validated throughout their lifecycle:

1. Arc (before submission)​

  • Missing membership information: Payer and member id
  • Missing gender
  • Missing address [most common problem]
  • Missing DOB
  • Missing DPSS office (when patient address is missing)
  • Missing Authorization Numbers (if applicable)

2. Stedi (on submission)​

  • General claims format, missing fields and invalid data. [we don't usually get errors here because Arc is doing validations before]

3. Health Plan​

  • Incorrect membership information [member id is invalid]
  • Claims rejections
  • Claims status & Errors The following Looker Dashboard was built to:

Looker​

The following Looker Dashboard was built to:

  • Report errors
  • Metrics