This standard defines the choreography for reporting Claim Detail Record Discrepancies depicted below.
Unless specifically agreed otherwise between the Licensee and the Licensor, a Licensee may only send one Claim Detail Record Discrepancy Notification for each Claim Detail Message (or equivalent) received; for the purpose of this, Corrections are considered new Claim Detail Messages.
Items in Claim Detail Message(s) received that are not subject to any discrepancy may be progressed in accordance with relevant licence agreements.
A Claim Detail Record Discrepancy Notification created in accordance with this Profile comprises:
- One Header Record
- 1-n Summary Record
- One or more Discrepancy Records
- One Footer Record
Details about these Record Types are provided in Part 2 of this Standard.
To indicate that a Claim Detail Discrepancy Notification is created in accordance with Profile, the
Profile Cell in the Header Record shall be set to
RecordDiscrepancy and the
ProfileVersion Cell to 1.0.