EHC^E04
Re-Assess HealthCare Services Invoice Request
This message is used to submit a single Re-Assess HealthCare Services Invoice Request to a TPA/Payer for processing. The Re-Assess HealthCare Services Invoice Request is used by a Provider, to request review of a previously adjudicated HealthCare Services Invoice, with optional specification of a Product/Service Line Item within that Invoice. Note that the HealthCare Services Invoice need not necessarily be sent to a TPA/Payer using the EHC^E01 – Submit HealthCare Services Invoice: it may be manually submitted.
Adjudication for a HealthCare Services Invoice may be re-assessed either because background information, such as a Provider's billing rate may have changed or if some of the adjudication rules have changed since original adjudication of the Invoice.
Message Types
Message Type
Trigger Structure
Return Structure
Event Flow
TriggerE04
SendEHC_E04
ReceiveACK
ACK choreographyEHC_E04