After generating the claim, there are various steps you can take to address pending claims for all patients. These may include submission, placing them on hold, addressing rejections or denials, completing any necessary actions, ensuring pending payments, and more.
Let's deep dive and explore the actionability of these claims one by one in the Claims grid.
Topics Covered
- How To View Claims
- How to Proceed With Claims Pending for Submission
- Actions on Pending Documents
- How to Put a Claim on Hold
- Actions on Rejected/Denied Claims
- Pending Payments
Watch this video for a comprehensive walkthrough.
To view claims, perform the steps given below.
- Navigate to the System Menu > select Claims.
- To view all claims, select the All Claims tab.
- To filter the list select the required Claim Status and click Apply.
Once a claim is generated, it will be saved and await submission.
Saved Claims
- Select the Pending Submission tab to view all claims that are Saved and Saved with Errors.
- To transmit the saved claims, click Transmit All Claims.
- Click Yes on the confirmation modal.
Saved with Errors
- Click on the claim that is in Saved with Errors status.
Error(s) will appear at the top of the claim form in red and will be highlighted within a box in the respective area.
Take Action and Fix the Error
- For example, if the license number is missing: make sure to enter the license number.
- Click Save on the claim form.
- Then transmit the saved claim as explained above.
To Print Paper Claims
- Select the required claim(s) in Saved status.
- Click on the Three Dots icon on the top right.
- Select Print selected paper claims.
Claims marked with 'Add Electronic Attachments' set to 'Yes' will transition to a 'Document Pending' status. You can then include electronic attachments, such as screenshots, clinical images, x-rays, etc., for these claims.
- Select the Document Pending tab.
- The claims that require electronic attachments will be displayed here.
- Click on the claim > Add Electronic Attachment for CS Attachments, Or
- Navigate to the NEA Fast Attach Portal for NEA Electronic Attachments.
- For CS Attachments: Add the required electronic attachment on the slider. Once uploaded, the details will be shown below such as Attachment Name and Attachment Type.
- Capture Screenshot: You will require CS Screen Capture to obtain a screenshot of the system.
- Scanner: You can scan the physical document to get an electronic attachment.
- Browse File: You can upload attachments saved on your computer.
- Attach Clinical Images (X-ray): You can attach clinical images from the SOTA imaging provider integration.
- Click Upload & Submit.
If you want to skip the attachments and want to transmit the claim anyway,
- Click Force Submit on the form [OR] open the drop-down menu under the Claim Status column in the Document Pending page > click Force Submit.
- Click Force Submit on the confirmation modal.
To put a claim on hold,
- Select the Pending Submission or Document Pending tab.
- Open the drop-down menu under the Claim Status column > click On Hold.
- The claim will be moved to the On Hold tab.
To view the claims that are on hold,
- Select the On Hold tab.
When you choose a claim that is on hold, you can view the note on the right side to understand the reason for its hold status.
| Note: In the 'On Hold' listing page, you can see some claims with errors. You can click on them to fix the errors and then click save to proceed as explained above. |
The clearinghouse can reject or deny a claim for various reasons. These claims will be populated in the Rejected tab or Denied/Action Required tabs.
To know the reasons for rejection or denial:
- Select the Rejected/Denied tab > Click on the rejected claim.
- Claim Rejection: There will be a note on the right side that states the reason for rejection or denial.
- If no note is present but there is a combination of letters and numbers, hover over the letters and numbers to view the rejection reason.
- Code Rejection: You can also click the Denials/Rejections tab on the form to see the Denial Codes and Rejection Details if the claim has rejections at a code level.
There may be situations wherein you have posted a Payment towards a Claim, but then realize there are some errors and you need to Reopen a rejected claim.
To reopen a rejected claim:
- Select the Rejected tab for example (can be done in any tab except pending submission and document pending)
- Open the drop-down menu under Claim Status > click Reopen.
- Enter Remarks to display the reason for reopening the claim > click Yes.
Pending Payment is the default status of a claim after it has been submitted to the insurance. It indicates that the claim has been sent out and is awaiting action from the payor. Once the claim is submitted, and the payment is pending, it will be reflected on the Pending Payments tab.
To appeal for specific codes that the insurance has not paid for, you can reopen the claim if it is closed. For this:
- Click on the drop-down menu under Claim Status.
- Click Resubmit after making any desired changes on the claim form.
Practices can utilize this comprehensive guide to understand how to manage various stages and scenarios encountered during the claims submission process after they have been generated.