Description:
Only Team Leaders and above have the capability of deleting unresolved claims from claims history. A record of deleted claims is maintained by the system and can be accessed using a PS01 transaction. The policy described below has been established to provide guidelines for deleting claims.

Policy Statement:
Claims deferring for reasons listed below can be deleted without supervisor approval.

NOTE:  All deleted claims should be logged on INFORM (as an internal item). INFORM entries should be informational to include date of service, claim number and specific INFORM complaint code.

1. Incorrect identification number when research concludes that patient has no Blue Cross coverage or that claim should be filed elsewhere. This category would include claims for HMO coverage, PAI coverage, Blue Rx claims, Medco claims or claims that should be filed to other plans. 
2. Adjustments that have been keyed and the system cannot adjudicate (i.e. change in group number).
3. Claims for dependents that are not covered if the group has dependent verification.
4. Blue-on-Blue claims if dependent children are covered but no coverage exists for ex-spouse.

If applicable, copies of deleted claims should be routed to the appropriate area for handling or else returned to the subscriber or provider with explanations.

If the above criteria is not met, a supervisor must approve the delete.