You must have Billing permissions to resubmit a claim.
Before You Begin
The following workflow is for Apex users.
Resubmitting a Claim
- Click Billing from the primary navigation bar.
- On the sidebar navigation click Claims.
- Click Rejected/Denied tab. If you do not see your claim check the date range. The max range you can run it for is 6 months.
- Your rejected/denied claims will show with the rejection reason. If the rejection reason does not show please scroll to the right select Actions > View Claim History and the Rejection reason will be listed *NOTE- If your claims are not in the rejected tab and you need to resubmit a claim- locate your claim > Update Status > Rejected/Denied*
- Correct the error in the client's profile or invoice and save the page where the update is being made.
- Return to Billing > Claims > Rejected/Denied and click Update Status. Choose Resubmit 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"
To send a Corrected Claim:
If you need to send a corrected claim (populate box 22 with a reference 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" and 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 claimOriginal 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: