EHC_E04

EHC^E04 – Re-Assess HealthCare Services Invoice Request (event E04)

8 segments · 1 events

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 Structure

8 segments
R RequiredO Optional Choice
MSH
R1
SFT
O*
UAC
O*
REASSESSMENT_REQUEST_INFOChoice
R1
IVC
R1
NTE
O*
PRODUCT_SERVICE_SECTION
O*
PSS
R1
PRODUCT_SERVICE_GROUP
O*
PSG
R1
PSL
O*
Used by Events:E04Re-Assess HealthCare Services Invoice Request