Topics EDI Failed Claims Search:  

Introduction

Returned claims screen enlists the Claims rejected either at Clearing House Level or at Payer Level.

Action Icons

Track Status: Tracks the claims status like the number of times the claim got sent, rejected, and reopened.

Claim Notes: It is used to write notes about the claim for internal documentation purpose.

Option PRI: Displays all the primary insurance claims (as mentioned during patient registration) that have been rejected or returned either at the clearing house level or the payer level.

Option SEC: Displays all the secondary insurance claims (as mentioned during patient registration) that have been rejected or returned either at the clearing house level or the payer level.

Note: PRI/SEC is radio button selection and hence at a time only one option can be chosen.

Filter: User can apply Filter on following fields to build the list accordingly by selecting one of the following filter and click button Apply Filter

  • DOS
  • Patient Display Name
  • Provider Display Name
  • Insurance Name
  • Batch No
  • Status
  • Ub04 Y/N

Note: The selected filter can be further sorted out by entering the apparent value in the empty text box placed next to drop-down: Filter and click button Apply Filter

The columns that are displayed are

DOS: Date of Service/Encounter Date.

POS: Place of Service used on the Claim.

Patient: Name of Patient.

Provider: Name of Provider.

Insurance: Name of the Insurance.

Batch No: Batch number of the claim submitted.

Status: Claim Tracking Status Code is a hyperlinked Status Code that invokes a pop-up 'EDI Claim Current Status'. It is possible for an user to change the current status of rejected claim and replace it with a more appropriate status code by selecting appropriate status on pop-up 'EDI Claim Current Status'. The new status for the rejected claim is retained once it is saved using button 'save'.

Note:

  • When user modifies the claim track status and clicks on OK, the corresponding claim row on the Claims > Returned list will immediately reflect the new status in the hyperlink, along with corresponding legend on its Tooltip. User can continue to change the claim track status for more than one claim by using the popup.


  • The modified claim track status for such claims will be lost if user does not click on the SAVE action button at the bottom of unpaid claim's list. After modifying the claim track status code, a user needs to click on SAVE action button near the end of returned claim's list and then re-process to process the modified claims.

Send Date: Date on which Claim was sent by EDI.

EDI Error: Hyper linked Edi Error Comment. User can click on hyperlink to view the claim rejection details. The pop up also allows user to input his/her own comment about the rejection reason, which is then displayed as hyperlinked, under error column on this screen.

Charge: Claim Amount billed to Insurance.

Hyperlinked columns allows sorting up on click. These columns are

  • DOS
  • Patient Display Name
  • Provider Display Name
  • Insurance Name
  • Batch No
  • Status
  • Send Date

Count: It is total number of Pri/ Sec rejected claims displayed on returned screen.

Total: It is sum total of total billed amount to claims rejected towards insurance companies for Primary/ Secondary Claims according to radio button selection for PRI/SEC.

save: Button 'save' retains the changes done to status of the selected claim.

re-process: Button 're-process' enables rejected claims to be reprocessed again after changing to appropriate status using pop up 'EDI Claim Current Status' invoked up on click of hyperlinked status code.