Manual rebill

Outcome

A denial that the engine couldn't fix gets a clean manual rebill — you identify the root cause, fix it where it lives, and rebuild + submit under a parent/child relationship.

Prerequisites

Scope	What it lets you do
billing.denial.read	Read the denial
billing.claim.write	Reverse + rebuild
billing.charge.write	Edit charges if root-cause is a charge

When manual is the right call

Rule of thumb: the engine is wrong is rare. Most manual rebills are the engine doesn't cover this case. If you're tempted to manually rebill on top of a SUCCESS, stop and ask why the auto-rebill is itself denying.

Steps

1. Open the denial. Read the CARC and any RARC. Note the original claim ID.

2. Click Open in rebill. The platform reverses the original claim:

   • Pricing rows reverse.
   • Auth used_units releases.
   • Charges unlock to VALIDATED.
   • The claim moves to REBILLED (terminal).

3. Identify the root cause. The CARC + RARC pair tells you most.

   Pattern	Fix where
   Wrong modifier	Charge or rule
   Missing auth	Attach auth (2.5)
   Wrong dx	Charge edit (2.6)
   Wrong DOS	Charge edit
   Wrong member	Charge edit (or void + re-build under correct member)
   Coverage stale	Refresh eligibility (2.4)

4. Make the fix. Each edit captures a reason.

5. Re-build the claim from the same charges. The new claim's parent_claim_id points at the original. Submit per 3.1.

6. Update the denial. The denial flips to RESOLVED once the rebill's 277CA accepts. Until then, set a follow-up date on the denial; the worklist surfaces it red if the date passes.

When the cause is upstream

Sometimes the root cause is in the EMR (wrong code mapped, wrong DOS sent). The right move:

1. Tag the denial with mapping-suspect or clinical-error.

2. Hold the rebill (don't reverse yet). The denial sits at IN_PROGRESS with the tag.

3. Coordinate: file the upstream fix; once the corrected charge re- ingests, reverse-and-rebuild.

This is slower but keeps your audit trail honest — rebuilding the same data and expecting a different result invites repeat denials.

Mass manual rebill (after a rule fix)

After admin fixes a configuration error that produced many similar denials:

1. Filter denials to the affected CARC + payer + date range.

2. Bulk select, Trigger auto-correction. Many of these will succeed automatically with the new rule.

3. For the residue (handlers don't cover this case), you can do a Bulk reverse + rebuild (with supervisor scope), but typically you walk these one at a time — it's safer.

Validation

Check	Expected
Original claim's status is REBILLED after reverse	Yes.
New claim's parent_claim_id points at original	Yes.
Auth used_units net-zero across reverse and rebuild	Yes.
Denial flips to RESOLVED after 277CA accepts	Yes.

Troubleshooting

Symptom	Cause	Fix
Open in rebill greyed	Original is WRITE_OFF or already REBILLED	Look at Relationships; act there.
Rebuild fails the same validation	Edit didn't address root cause	Re-read the CARC; fix again.
Engine ran and you manually rebilled	Both produce children — duplicate of each other	Reverse the manual one (your audit row will show it was avoidable).
Rebill submitted but never accepted	New 277CA rejected for a different reason	Triage as a new denial; the chain depth grows.

Where to next

• 5.5 — File an appeal — when rebill won't fix it.
• 5.7 — Force-retry & overrides — supervisor escalation paths.