Creating Claims

Purpose

Accurate and timely claim submission is critical for maintaining a healthy revenue cycle. A consistent claim submission process ensures that claims are properly prepared, transmitted without delay, and monitored until payment is received. By following a standardized workflow in CareStack, practices can reduce claim errors, minimize rejections, and improve insurance collections.

This Standard Operating Procedure (SOP) outlines the recommended steps for generating, reviewing, submitting, and monitoring insurance claims within CareStack. Establishing a daily routine around claim management helps the billing team maintain accuracy and ensures that insurance claims move efficiently through the reimbursement process.

 

1. Generate Batch Claims (Daily)

• Go to Claims Grid

• Select Generate Batch Claims

• Apply the following filters:

  • Claim Channel: All

  • Locations: Select applicable location(s)

  • Providers: All

  • Date of Service: Use the default 3-month range

For best results, if daily claim batching has not yet been established, we recommend generating a batch with a date range beginning from your go-live date to ensure that all claims are captured and none are left behind.

• Generate the batch
• Claims will automatically move to Pending Submission Tab

 

2. Review Claims Before Submission

• Navigate to Pending Submission Tab

• Review claim status:

  • Saved – Ready to process

  • Saved with Errors – Requires correction

• Open any claim with errors and correct missing information before continuing

 

3. Transmit Claims

• Select Transmit All Claims

System Behavior:

• Claims without attachments

  • Automatically moves to All Claims tab

  • Status becomes Ready to Send

• Claims must be in Ready to Send status to be included in the nightly clearing house transmission @ 8PM EST

• Claims requiring attachments

  • Automatically moves to Document Pending Tab

 

4. Claims Requiring Attachments

Add Electronic Attachments using CS Attachments

• Go to Claims

• Grid Select Document Pending Tab

• Open the claim

• Select Add Electronic Attachments 

• Review attachment recommendation box for guidance

• Upload documentation using:

  • Capture Screenshot

  • Scanner

  • Browse File

  • Attach Clinical Images

  • Attach Perio Chart

  • Attach Notes (as narrative)

• Label and identify attachments

• Save and Close

• Select Upload and Submit

Result

Claim moves to All Claims → Status: Ready to Send - Seeing the Ready To Send status paired with a specific Attachment ID Ex ( #DXC106180546 ) is the definitive confirmation that your documentation is correctly linked. 

 

5. Managing on Hold Claims

• Go to Claims Grid → On Hold Tab

• These claims are paused for internal review

• Status will display On Hold

Use Claim Flags to identify needs for claims placed on hold intentionally 

To resume processing:

• Change status to Saved

• A toast notification will appear on the top right stating, 'Claim(s) saved successfully.'  

• Claim will automatically move to Pending Submission Tab

 

6. Rejected / Denied / Action Required Claims

Review and Correct

Navigate to ‘Rejected’ & ‘Denied / Action Required’.
Use Claim flags to identify needs for claims that have been rejected

Common Statuses:

• Rejected

• Rejected (CH) - Rejected by the Clearing house

• Error (Payor)

• Req Addl Info (Payor)

• Partially Paid

• Denied

Steps

• Review rejection reason

• Correct the issue

• Resubmit the claim

 

7. Pending Insurance Payments

Monitoring Insurance Claims

Navigate to Pending Payments Tab

These Claims:

• Were successfully submitted

• Are in an accepted claim status

• Are waiting for payment

• Count toward Insurance Aging

Key Columns to Monitor:

• DOS – Date of Service

• Last Updated – Last claim activity

• Ins. Expected – Estimated insurance payment

• Carrier – Insurance company

• Aging – Days since claim submission

• Claim Flag – Custom tracking tags

• Claim Status – Current claim stage

Follow Up Guideline

If a claim has not been updated in 30 days per the Last Updated Column, contact the insurance carrier for status.

 

Quick Workflow (Daily Routine)

Daily

• Generate Batch Claims

• Fix Saved with Errors

• Upload any attachments

• Transmit All Claims

Weekly

• Review Rejected & Denied claims

• Review On Hold Claims

• Work Pending Payments aging

Follow up on claims 30+ days outstanding

• Generate Batch Claims

• Fix Saved with Errors

 Best Practice Tips

• Run batch claims daily

• Resolve claim errors immediately

• Track claims with Claim Flags

• Follow up with insurance at 30 days

• Following up on claims by aging and carrier will reduce time spent.