How-to

Amending a rejected claim

Fix errors on a rejected or failed claim and resubmit.

When a provider rejects a claim, Light keeps the prepared payload so you can fix the issue and resubmit without recording the encounter again.

Why a claim gets rejected

Common reasons the provider rejects a claim:

  • Identity mismatch — Medicare number doesn't match the patient record at the provider
  • Expired Medicare — Medicare number valid format, but expired
  • Missing or invalid AHPRA number — the recorded vaccinator isn't recognised by the program
  • Ineligible patient — age, cohort, or prior-dose rules not met for the program
  • Duplicate claim — the provider already has a claim for this service from your pharmacy or elsewhere

The exact reason is shown as an error message on the claim — Light passes the provider's response through unchanged.

Amending

  1. Open the Rejected card

    On the Claims page, tap the Rejected status card to filter.

  2. Open the Amend sheet

    Tap Amend claim in the row's actions column. The Amend Claim sheet opens, with the program in the title (NIPVIP, CVCP, MedsCheck).

  3. Read the error

    An alert at the top of the sheet shows the rejection reason from the provider. This tells you what needs to change.

  4. Edit what's wrong

    The sheet exposes the fields you can amend on a rejected claim — typically the pharmacist's AHPRA/name, service date, batch or dose detail, and program-specific flags. The exact set varies by program (NIPVIP, CVCP, MedsCheck).

    Patient identity, vaccine brand, and AIR code are read-only here — changes to those need to happen on the underlying encounter first. If the rejection points at one of those, see the identity-problem flow below.

  5. Save and resubmit

    Tap Amend & Set Ready. The claim returns to Ready status. Open it again from the Ready card to resubmit — the Submit sheet now uses the amended data.

When the amend sheet isn't available

Some rejected claims can't be amended from the claims page:

  • No prepared payload — the amend action is disabled with a tooltip explaining this. Fix the underlying encounter and the claim will regenerate.
  • Terminal state without amend permission — some Failed or Ineligible claims don't have amendable fields. Record a new encounter if the service was genuinely delivered.

When the error is an identity problem

If the provider rejects for identity reasons (wrong Medicare, expired Medicare, name mismatch):

  1. Fix the customer's record on their profile — not the claim
  2. Re-open the encounter and resubmit the form
  3. A new claim is prepared; the old rejected one stays for audit

For the mechanics of editing customer identifiers, see Editing customer details.