The Question
If I edit a case that's already marked complete and was already pulled by my billing department, for example, fixing CRNA start/stop times to resolve a concurrency hold 30 days later, does that create an amendment? And how does my billing team know the case changed since the last data dump?
How It Works
Each billing interface (one per facility) sends cases in the nightly files, a discrete data file plus a PDF for each case, the day following either:
- The day a case is first marked 100% complete (typically date of service + 1), or
- The day after a case is later updated with new information.
A case is sent the first time once it reaches 100% complete, and then the entire case (discrete charge and demographic data + PDF) is retransmitted each time it's updated afterward. You always receive the full, current version of the case — not a partial amendment.
How to Identify an Updated Case
Use the FormId field (Field #8 in the billing interface spec). FormId is the unique Graphium identifier for each case, unique across your organization, and your billing software should store it. When a case comes through, match on FormId: if you've seen that FormId before, it's an update to a case you already have, replace your prior copy with the new transmission.
Common Questions
Does editing a completed case create an amendment record? No. Graphium does not create a separate amendment. It retransmits the entire updated case in the next nightly file.
How does my billing team know a case changed since the last download? The full case is resent in the nightly file the day after the edit. Match incoming cases on FormId, if a FormId repeats, it's an update to a case you already received, and you should replace your prior copy with the new version.
What field uniquely identifies a case? FormId (Field #8 in the billing interface spec). It is unique to each case across your entire organization and is the value your billing software should store and match on.
When is a case first sent to billing? The day after it's first marked 100% complete, typically date of service + 1.
Do I receive a partial update or the whole case when something changes? The whole case, every time, the complete discrete charge and demographic data plus the PDF.
Will every edit trigger a retransmission? Yes. Any time a completed case is updated with new information, it's resent in full in the next nightly file.
Is there a limit on how long after a case is closed that an edit will still be sent? No. Even a case that's 30+ days old will be retransmitted in the next nightly file if it's edited. That's why matching on FormId matters, your billing system should expect to receive updates to older cases.