Checking claim status

In the left sidebar, under Billing, click Claims to see where an insurance claim stands after it has been created or submitted. You can also open a patient's claims when you are already working in that chart: in the left sidebar, click Patients, click the patient's name, then click Claims in the patient chart's Billing section.

How do I find a claim and open its status?

In the left sidebar, under Billing, click Claims to open the organization-wide claims queue and review a claim's current status. The queue groups claims by status, and selecting a row opens the claim details panel.

Use the Claims (1) link in the left sidebar to open the queue, and use Updated (2) when you want to narrow the list by when claims were last changed.

1. In the left sidebar, under Billing, click Claims.
2. Open the status group that contains the claim.
3. Select the claim row.
4. Review the claim's status in the details panel.

The claim details panel stays open beside the list, so you can move between claims without leaving the queue.

How do I review payer and clearinghouse responses?

In the left sidebar, under Billing, click Claims. Use the claim details panel in Claims to read the information returned after a claim is submitted or updated. Responses can appear as messages, alerts, payment information, attachments summary, history events and, for submitted claims, Sent as. When a submitted claim shows Sent as, that field reflects Box 22 on the claim.

1. In the left sidebar, under Billing, click Claims.
2. Select the claim row.
3. Review Messages for payer or clearinghouse text returned on the claim.
4. Review alerts for items that need attention or review.
5. Review Payment Summary when payment, patient responsibility, writeoff or denial amounts are available.
6. Review Attachments when the claim includes documents sent with the submission.

Payer alerts can include payer reason-code details when those are returned. Use the message and alert text to decide whether the next step is to wait, correct the claim or post remittance.

How do I see when a claim status changed?

On the same page, use History in the claim details panel from Claims to see the timeline of claim activity. History shows submissions, status updates, payer or clearinghouse outcomes, copay collection, invoice handling, and other events in the order they were recorded. For submitted claims, the details panel also shows Sent as so you can see how Box 22 was filed.

Open the History tab (1) to see the claim's activity timeline, and review each Timeline entry (2) for when it happened and what it records.

1. Select the claim row.
2. Open History.
3. Review the timeline for status and remittance events.

Common history events include Status update received, Acknowledged by payer, Accepted by payer, Rejected by clearinghouse, Denied by payer, Payment received, ERA received, Copay collected, Held copay applied, Invoice ready to send, Invoice not updated and Card charge scheduled. Events show when they happened and, when available, who or what recorded them.

How do I check claims from a patient's chart?

In the left sidebar, click Patients, then click the patient's name. Use a patient's Claims page when you only need claims for one patient. This page scopes the claims list to that patient.

Use the Claims (1) link in the patient's Billing section to open that patient's claims page.

1. In the left sidebar, click Patients, then click the patient's name.
2. In the patient chart's Billing section, click Claims.
3. Select the claim row.
4. Review the claim's status, messages, alerts, payment summary and History.

The same claim can also be found from the organization-wide Claims queue.

What can't I do here?

Claim status access is limited in these ways:

• Clinicians do not have access to the full operational claims queue.
• If insurance claims are not enabled for your organization, Claims is not available and the patient claims page sends you back to the patient's main record.
• A patient's Claims page, opened by clicking Patients in the left sidebar, clicking the patient's name, and clicking Claims in the patient chart's Billing section, is scoped to that patient. Use Claims for the organization-wide queue.
• On an archived patient's claims page, you can still open and read a claim, but status-check actions are disabled.

Common questions

Can I check status without leaving the patient's chart?

Yes. In the left sidebar, click Patients, click the patient's name, then click Claims in the patient chart's Billing section. Select the claim row to review its details and History.

Where do payer messages appear?

In the left sidebar, under Billing, click Claims, then open the claim details panel. Payer and clearinghouse text appears in Messages when it is available. Status-related events appear on History.

What do alert severities mean?

Error means a claim problem needs attention. Warning means the claim may need review before the next billing step. Info is a note or non-blocking detail to review.

What should I do if the claim is rejected or denied?

In the left sidebar, under Billing, click Claims, then open the claim details and read the returned messages and alerts. If the claim needs a replacement or resubmission, see Correcting and resubmitting claims.

Where do payment and ERA details appear?

Payment information appears in the claim details when available. For submitted claims, Sent as also appears there. For remittance workflow and copay or invoice activity, see History and Posting ERAs and remittances.