Reference 0011

Claim Follow-Up Action Card

A quick reference for choosing whether to resend, replace, void, appeal, or only track status.

Use this when a workflow says "resubmit" but the claim may already have been accepted or adjudicated.

Action Codes

Code	Meaning	Preserve
RES	Correct and resend after rejection.	Rejection reason, correction task, transmission attempt history.
REP	Replace or correct an accepted/adjudicated claim.	Original submitted snapshot, payer reference, replacement chain.
VOI	Void or cancel an accepted claim.	Original claim, cancellation reason, payer response.
APL	Appeal or request reconsideration of a payer decision.	Denial reason, clinical evidence, deadline, appeal packet.
STS	Track claim status without changing claim facts.	Status response, checked-at time, next follow-up date.

Core Invariant

Accepted claim history is append-only. After acceptance or adjudication, create a follow-up action instead of overwriting the submitted claim snapshot.

Fast Triage

Question	If Yes
Was the claim rejected before payer adjudication?	RES
Was the claim accepted, but submitted facts need correction?	REP
Was the claim accepted, but it should not exist?	VOI
Are the claim facts right, but the payer decision is disputed?	APL
Is the signal only telling you where the claim is in process?	STS

Source Anchors

CMS Electronic Health Care Claims describes rejection for correction and resubmission before later payer coverage and payment policy edits.
CMS MLN Billing Information identifies claim codes and additional claim information as NUCC-designated billing information for CMS-1500 and 837P.
NUCC 1500 instructions maintain the professional claim form instruction manual.
Medicare.gov Filing an Appeal explains appeal as the route when disagreeing with a coverage or payment decision.