Rebill & correct

Outcome

A claim that was rejected (277CA) or denied (835 with CO adjustments) is corrected — either automatically by the engine or manually by you — and a new claim flows out under a parent/child relationship that preserves audit history.

Prerequisites

Scope	What it lets you do
billing.claim.read / .write	Reverse and rebuild
billing.charge.write	Edit charges that need fixing
billing.denial.read	Trace the denial that triggered the rebill

The rebill model

Every rebill carries parent_claim_id pointing at the originating claim, so audit and reporting can walk the chain. The original claim moves to REBILLED (terminal), the new one starts at CREATED.

When the engine handles it (most CARCs)

The auto-correction engine has handlers for common CARCs. If you see a SUCCESS row on the denial's Auto-correction tab, it has already built and submitted the rebill. Don't manually rebill on top of it.

CARC	Handler	What it does
CO-4	CO4ModifierHandler	Re-injects modifiers and rebuilds.
CO-16	Co16MissingInfoHandler	Attaches missing info / auth and rebuilds.
CO-29	Timely-filing handler	Generates appeal envelope (timely-filing exception) where rules allow.
CO-18	Duplicate handler	Marks the duplicate; no rebill (the original paid).
CO-97	Bundling handler	Re-codes per CCI rules and rebuilds.
CO-197	Auth handler	Attaches auth and rebuilds.

See 5.3 — Auto-correction console for the full handler list and how to override.

Manual rebill

When the engine can't fix it, or the engine has tried and failed:

1. Open the denial at /denials/:id. Read the CARC and any RARC.

2. Click Open in rebill. The platform reverses the original claim (reverses pricing, releases the auth's used_units), unlocks the charges, and opens the Edit charges view.

3. Make the fix. Edit the charge that triggered the denial — wrong modifier, wrong code, wrong DOS, wrong unit count. See 2.6 — Edit / correct a charge.

4. Re-build the claim from the same set of charges. The new claim inherits parent_claim_id. Submit per 3.1.

Adjust a paid claim

Rebill is for claims the payer refused. When the payer has already decided a claim — it is PAID, RECONCILED or DENIED — and something on it was wrong, send an adjustment: a new claim that replaces the original with the payer (CLM05-3 frequency 7, REF*F8 = the payer's claim number for the original).

1. Open the claim and click Adjust in the header. The button shows only on a PAID, RECONCILED or DENIED claim with no open adjustment.

2. Check the reference. The dialog shows the payer claim number (ICN) REF*F8 will carry. When no ICN has come back on a submission yet, it warns that the claim's patient control number is sent instead.

3. Enter a reason and make the fix. Header: billing provider, location, program. Per line: rate code, CPT, rendering and referring provider, dates of service, diagnosis, units and charge — beside what the payer paid on the line. Only what you change is sent.

4. Add a service line for a service the original did not bill: click Add service line and enter the CPT, modifiers, dates of service, rendering provider, diagnosis (one already on the claim), units and charge — and the revenue code on an institutional claim. Added lines are numbered after the existing ones, count in the claim total, and are not tied to a charge; the payer's 835 posts their payment.

5. Set a delay reason if the earliest date of service is more than 90 days old. The Delay reason (CLM20) picker appears; the adjustment is still created without one, with a warning.

6. Click Create adjustment. The new claim opens at BUILT. Scrub it and it is sent like any other claim.

The original keeps its status and shows Adjusted — replaced by with a link to the new claim; the new claim shows Adjustment of with a link back. A claim has one open adjustment at a time — to correct it again, adjust the newest claim. Nothing is posted to the ledger at adjustment time: the payer's 835 takes back the original payment and pays the replacement.

Merge claims

When a denied visit belongs on a claim the payer already paid, merge the two from the Claims list. A merge is always exactly one paid claim and one denied claim:

• The paid claim is adjusted: a replacement (CLM05-3 7, REF*F8 = its payer claim number) carries its service lines followed by the denied claim's, with the total and dates of service recomputed.
• Nothing is sent for the denied claim — no void, no replacement. Its charges move to the replacement, which now bills them, so the denied claim reads $0, and its open denial is closed as CORRECTED with the replacement as the response claim. Nothing is written off.

1. Select one PAID (or RECONCILED) claim and one DENIED claim on the Claims list — same member, payer, billing provider and claim type. Merge is enabled only for that pair.

2. Click Merge in the selection bar. The dialog reads Adjust <paid PCN> (replacement) + close <denied PCN> at $0 and shows the replacement's dates of service and total.

3. Enter a reason and click Merge claims. The replacement is built at BUILT and opens. Scrub it and it is sent like any other claim.

Neither claim can be adjusted or merged again — work the replacement. Nothing is posted at merge time: the payer's 835 takes back the old payment and pays the replacement.

A denied claim that is itself a rebill of an earlier claim cannot be merged yet: merging rebill chains is not supported, and the list says so.

Reversing without rebuilding

You can reverse a claim without immediately rebuilding when the charge needs upstream-EMR repair. The reversal:

• Releases used_units on attached auths.
• Reverts pricing rows.
• Sends the charge back to VALIDATED (or NEEDS_FIX, depending on re-validation).

You'll rebuild when the upstream fix is done and the charge re- validates.

Mass rebill (after a rule fix)

Sometimes a denial pattern traces to a stale rule (e.g. you missed a modifier-injection rule for a payer). After admin fixes the rule:

1. Filter denials to the affected CARC and date range.

2. Bulk select, click Trigger auto-correction. The engine re-runs all selected. Rows that the new rule fixes get SUCCESS rebill rows.

3. Watch the worklist. Successful rebills move to RESOLVED; failures stay open for manual handling.

Validation

Check	Expected
Original claim status flips to REBILLED	Yes (terminal).
New claim's parent_claim_id points at original	Yes; visible on the Relationships tab.
used_units on auth releases on reverse, re-consumes on rebuild	Yes; net-zero on a successful rebuild.
Audit log captures reverse + rebuild as separate events	Yes.

Troubleshooting

Symptom	Cause	Fix
Open in rebill greyed	Original claim is already REBILLED or WRITE_OFF	Look for the child claim on Relationships; act there.
Re-built claim fails the same validation	Your edit didn't address the root cause	Re-read the CARC text + RARC; sometimes the fix is in the auth, not the claim.
Engine ran but SUCCESS rebill is also denied	New denial has a different CARC	Triage as a fresh denial; the chain depth grows.
used_units exceeds approved after rebuild	Rebuild ran while a parallel claim was billing	Reverse one, rebuild the other; ask admin to consider an auth amendment.

Where to next

• 3.4 — Void & replace — for the cases that need a payer-side replacement (frequency code 7 / 8).
• 5.3 — Auto-correction console — the engine in detail.