If you need to make changes to a previously submitted claim, whether it’s correcting errors, updating personal or provider details, modifying service dates, adjusting billed amounts, or adding supporting documentation, you can easily edit the claim information and resubmit it.
Correct and resubmit claims
From the Application Dashboard, click Claims.
Click on the Encounter # to open the encounter.
After making the necessary edits, click Manage Claims.
Click the Checkbox to select the payer.
The Suppress Previous Payment Information on a Claim option is available when resubmitting a claim. Use this if a payment has already been posted and you don't want the payment amount included on the resubmitted claim.
Click Create Claim.
On the Create Claim screen, choose the appropriate Resubmission Code from the drop-down menu.
- If the claim is Sent Out and it’s a medicare claim, resubmission code 7 will not be an option it’ll automatically default to resubmission code 1.
- If the claim is Sent Out and it’s not a medicare claim, resubmission codes 1 and 2 will not be an option, it’ll automatically default to resubmission code 7.
- If the claim status is Rejected and not a medicare claim, resubmission code 7 will not be an option it’ll automatically default to resubmission code 1.
- If the claim status is Rejected and is not a Medicare claim we check the claimstatusentityidentifer code value as below:
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- ClaimStatusEntityIdentifierCode is “AY” - this is a field received from the clearinghouse (ClearingHouse - Claim Status Entity Identifier related to 277CA). The resubmission code is set to “1”.
- ClaimStatusEntityIdentifierCode is “PR” - Resubmission code is set to 1.
- In all other cases, we default it to “1”.
If the claim is being resubmitted to Medicare or BCBS, the Original Ref No must be replaced with the ICN number.
To add additional claim notes in Box 19 on the 1500 claim form, select the desired option from the Claim Notes drop-down menu and enter the details in the field.
Click Send Claim. The system will then move the encounter to the Scrubbing for Errors tab for claim scrubbing. You’ll notice a message in the Encounter screen indicating that Claim scrubbing is in progress. Once the claim scrubbing is completed without errors, the claim will be sent directly to the payer.
Additional details
When resubmitting claims rejected due to the Rendering Provider's NPI number, updating the NPI on the Rendering Provider screen (under Utilities) will automatically update the claim form. You can then resubmit the claim directly from the Rejected tab, no need to manually manage the claim.
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