Permissions

TheraNest users with Billing Permissions AND permissions to submit claims to the clearinghouse will be able to complete the steps below. 

Before You Begin
This workflow is only for non-apex users. Click here for Apex workflow.

Steps on Correcting and Resubmitting

  1. Click Billing from the Primary Navigation Bar
  2. Choose Claims on the side menu
  3. Click the submitted tab.  The submitted tab will show all claims submitted in the last month.  You can expand the date range.  Mark the claim as failed by clicking Status next to the claim and choosing Failed/Rejected from the dropdown.
  4.  Correct the error in the client's profile or invoice and save the page where the update is being made.
  5. Return to Billing > Claims > Submitted > mark as rejected/failed then resubmit a new claim. 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 need to populate box 22 with the original claim number you will need to follow these instruction before you resubmit the claim. 

Go to Billing > Insurers > Edit. Then under EDI file settings check the last box that reads  "Ask for resubmission details prior to Re-Submit failed claim" Save Changes. 

When resubmitting the claim a dialogue box will pop up asking you to choose the resubmission code and enter the original reference number for the claim. 

Resubmission Code = 7 - replacement of prior claim
                                      8 - void/cancel of prior claim


Original Reference Number
(you may need to call the insurance payer to get the Original Reference Number).

Resubmission details appear in Loop 2300 of the EDI file and Box 22 of form CMS1500:

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