PLP ER Process


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  • ER PLP ByPass
  • Claim: 987654321
  • 1
  • Check Provider File For "New" Benefit Authorization Process Flag. (File: PROVIDER Field: PRFLG2).
  • 2
  • ER PLP ByPass (Beginning)
  • Check "New" File "Benefit Code Process File" (CLMBENBYP) against the Benefit Code Stored In Claims File (Field: CMLBCD). Benefit Codes: ("ERA"/ "ERB" / "ER1" / "ERV")
  • Entering claims through Batch process.
  • Claim: 987654321
  • Check Provider File
  • Check CLMBENBYP File
  • 3
  • Process Auto-Adjudication, if 2 & 3 are true. (Skipping EDI1830 Message)
  • Process claims through "Auto-Adjudication" if the both Benefit Authorization Flag (PROVIDER/PRFLG2 = "Y") And Benefit Code is found in the "Benefit Code Process File".
  • 4
  • ER PLP ByPass (The End)
  • ER PLP ByPass
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