The most common denied claim has to do with claims for the same member, billing code and date that were not all "approved" prior to sending billing via 837. This is because SpokeChoice aggregates them together for the entire day, member and billing code. If one or more of the claims is not approved those will not go out. Therefore the few that were uploaded, that were approved, will be paid. Upon later submission, after approvals on the remaining have been approved, the claims will deny because there is already a claim for that member, billing code and date that was paid. DDD has a method to use the time of day modifier (TOD) when first submitting the claim. SpokeChoice does not support this method because there could be multiple claims during the same Time of Day (ie: Morning time, 8am-9am and 10am-11am) and as such adding two claims with the same TOD will cause one to be paid and the other not. Therefore adding TOD modifiers could result in non-payment unless all claims for the day are "all" in different time periods, morning, afternoon, evening and night.

The way to avoid this is to never output a clients claims UNLESS all claims for that day have been approved. Should you make this mistake and ignore any warnings about this during output of the 837 you might need to void and replace a claim in Wellsky. To do this you can refer to the video under the learning center called "How to Void and replace in Wellsky"