How to Update Rejected Claims?

Claims > Claims Management > Processed 

Claims that did not pass the preliminary clearinghouse edit checks are placed in the ‘Rejected’ folder. This means that the claims were missing important information so they could not be admitted to the payer system for processing. Payers do not have a record of these claims because they never made it that far.

Follow the workflow above to navigate to the ‘Processed’ tab. Expand it to select ‘Rejected’ tab in order to view  the list of Rejected claims.

Rejected Claims

From the list of Rejected Claims, clicking on the ‘Patient’s name’ gives user an overview of the patient, provider IDs and submission information.

Patient Overview

Clicking on the ‘Appointment date’ shows user the information that is missing or incorrect.

Missing Information

Enter the correct information in the ‘Value’ field and click on the ‘Save’ button.

Once saved, click in the box in front of the corrected claim and click on ‘Mark as Corrected’. This moves the claim to the ‘Corrected’ folder.

Corrected Claims

Users can not update provider’s profile information from the rejected claims bucket.

This restricts unauthorized users from entering incorrect information, hence avoiding discrepancies.

System displays the erroneous information in the disabled state under the value column.

Missing Information Field

System also displays an ‘information’ icon next to the disabled value field. Hovering over the information icon displays a message in the tooltip stating:

”Provider profiles can only be updated from Settings. The change is systemwide [across all clinical and billing transactions]!!! No information should be changed unless the current provider profile has incorrect information.”

Tooltip

To learn about Provider Settings, click here.