Correct and Resubmit Electronic Claims

After submitting electronic claims, be sure to clean up any transmission or records errors, and re-submit if needed.

How to Get Here

Electronic Claims. In addition, the Electronic Insurance window opens whenever you initiate an electronic insurance form for a patient.

Use This Feature

Review Rejected Claims - We recommend that you return to the Electronic Insurance window immediately after transmission. Any claims that were not processed successfully remain in your pending claims list. In addition, you may retrieve rejected claim information from your electronic insurance clearinghouse. (See "Review Electronic Claims Online" for details.)

View Errors

- Review the details in the Claim Issues column to determine the reason the claims were not successful.

Correct Errors

- Go to the appropriate patient folders or other areas of your system to fix any record-keeping or other errors. Common errors include incorrect state abbreviations, mismatched relationship data, and missing employer and group number data.

2-Letter State Abbreviations - Electronic claims require the postal-approved 2-letter state abbreviation for all addresses on the insurance form. Review the patient and responsible party pages of your patient folders, as well as your Insurance Company and Employereditor for correct state abbreviations.

Relationship=Self - If the Relationship field on the Insurance detail page is Self, the Subscriber name must EXACTLY match the patient name.

Employer Required - The employer field on the insurance detail page of the patient folder cannot be blank: We recommend that you create an employer record for Self in your Employereditor to handle self-employed patients.

Group Number Required - The Group No. field on the Insurance detail page of the patient folder cannot be blank: Enter 999999 if the employer is Self.

Flag Claims to be Re-Submitted - If you have insurance claims that were uploaded, but then rejected by the clearinghouse or insurance company and need to be sent as re-submissions, go to the Insurance detail page of the patient folder, and set the Claim Submission Reason field in the Electronic Submission section of the window to Corrected. The claim will then be marked as a re-submission, rather than a first-time submission.See "Insurance Details" for details.

Select & Re-Submit Claims - Re-generate the insurance form(s) you need to resubmit, and open the Electronic Insurance window again. Select the claim(s) to transmit, and click Submit. The claims will be marked as re-submissions, rather than first-time submissions for the processing clearinghouse. (See "Upload Electronic Insurance Claims" for details.)

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