Identify the claims that have been denied, You can show denials on the Billcases tab by clicking the DE box. You’ll also need to ensure that you’re searching all billcases not just un-submitted cases which is the default. Optionally check TR so that you can quickly identify why they were denied.
You can identify why a claim was denied by mousing over the Denial Code (CO -16) in the example. This is the only information we get on the denial, so if you need additional details you’ll need to consult with the Insurance Company.
Once you’ve identified the issue, click to open the bill case. At the top click to make changes.
Adjust the bill case as needed, you can change anything you need here from the Diagnosis, insurance, procedure, biller, etc. Once you’ve made your changes click Update Billcase to save. If you make any changes to a charge item, make sure to scroll to the right and click Update Charge before updating the bill case.
To submit the corrected claim, click Submit Corrected Claim under actions. The system will ask you for any information it requires, you can leave this as the default unless something is missing.
The claim will automatically be checked to be included in the next batch, click Process Claims as you usually would to submit it to the clearing house.
To fix a Rejected claim:
. Identify the claim that was rejected, these will show up in the REJ column under Claims. Click the number in the column to show claims that were rejected in that batch.
Identify the issue that caused the rejection. This will appear in the Note column, or in the Note field in the individual claim. In this example they don’t like the diagnosis code. Once you know what the issue is open the claim by clicking .
To edit the bill case that created this claim click the icon next to Billcase.
At the top of the bill case click "Edit Billcase" to make changes.
Fix the issue with the claim, in this example you’d need to change the Secondary Claim Information. Make sure to click Update Charge after changing the Secondary Claim Information.
Before finishing editing click Update Billcase, once you return to the bill case screen scroll down to Actions and click Submit as New Claim.
The bill case will be marked for inclusion In the next batch of claims. Click Process Claims as you normally would to submit it to the clearing house.
