OBH Facets Claims Spanning Eligibility Dates

Original Effective Date	04/15/2009
Revision Date	09/03/2018

Overview

Purpose

This document provides general instruction for handling of claims that span across eligibility migration dates and receive the 50507 Claim spans Eligibility Dates error message. Follow all group-specific memos and guidelines, as applicable.

Procedures

Background

When a member has a change of eligibility event and a claim for that member has dates of service that span the changed eligibility date, the claim receives error message 50507 Claim spans Eligibility Dates. See Figure 1. To correct this error, Eligibility should be checked first. See Figure 2. If the benefits are different between the dates, then split the claim.

Figure 1: Medical Claims Processing — Error Message: Claim spans Eligibility dates. (Override / OK)

Figure 2: Eligibility Inquiry — verify eligibility rows (From / Through / Eligible / Subgroup / Plan / Product) for member DOS.

Step/Action

The following Step/Action table assists in detailing the handling for claims that span eligibility dates.

Step	Action
1	Note the member's Suffix on the Indicative section.
2	Open the Line Items section.
3	Note the dates of service.
4	Transfer to Eligibility/Inquiry (Transfer > Eligibility Inquiry).
5	Verify benefits for member's DOS on the claim.
6	Return to Line Items section.
7	Edit > Select to Move by Date — Split Claim Lines dialog opens.
8	Enter date new benefits became effective in From this date.
9	Click OK — selected lines removed from claim.
10	Edit > View Selected Lines.
11	Verify correct lines; Deselect incorrect lines.
—	Warning: Do not click Delete — line cannot be recalled.
12	Click Close on Selected Lines to Move dialog.
13	Change Total Charge to reflect charges of lines remaining.
14	Click (F3) (File > Process).
15	Press <Shift + F4> (File > Save > Accept/Continue) — new segment created.
16	Press (F3) to process new claim segment.
17	Press (F4) to save new claim segment.

Use <Shift + F4> as directed in workflow. To pend: <Shift + F8> or File > Save > Pend/Continue.

Code Descriptions and Terminology

Code Descriptions	EOB Codes List · Medicare Reason Codes · UM Service Group Code Glossary
Terminology	Optum Glossary of Terms, Abbreviations and Acronyms

Revision History

Date Published	Section	Revision Details	Writer	Approver
09/03/18	All	Converted to HTML file	JA	Management

Business Details

Platforms	Facets
Audience(s)	Auditor · Processor · Adjuster
State/DIV(s)	All
LOB(s)	Commercial
Product(s)	OBH
Documentation Contact	Content Management Intake