TheraNest users with Billing Permissions AND permissions to submit claims to the clearinghouse will be able to complete the steps below.
Before you begin:
Check your EDI file settings
- Go to Billing > Insurers
- Click on the insurer's name
- Scroll down to EDI File Settings
- Select "Ask for resubmission details prior to Re-Submit failed claim" in the EDI file settings.
- Click Save
End result this will fill box 22 of the CMS 1500 claim form: Resubmission Code/Original Reference number.
Steps on Correcting and Resubmitting
- Click Billing from the Primary Navigation Bar
- Choose Claims on the side menu
- Click Submitted tab. The submitted tab will show all claims submitted in the last month. If you do not see your claim check the date range. The max range you can run it for is 3 months.
- Mark the claim as failed by clicking Status next to the claim and choosing Failed/Rejected from the dropdown.
- Correct the error in the client's profile or invoice and save the page where the update is being made.
- Return to Billing >Claims > Submitted and click Status. Choose Resubmitted.
- A window will appear and say "Choose appropriate option below.." but the first time resubmitting only one action is allowed and that is to click the button "Resubmit & Create new Claim"
If you have to resubmit that claim for a 2nd or 3rd time you will have option to mark claim as submitted without creating a new claim.
8. If you enabled, "Ask for resubmission details prior to Re-Submit failed claim" in the EDI file settings to populate box 22 of the claim form, enter the required resubmission details:
Original Reference Number (you may need to call the insurance payer to get the Original Reference Number).
6. Click Re-Submit.
Resubmission details appear in Loop 2300 of the EDI file and Box 22 of form CMS1500: