Introduction
The Returned Claims screen lists the claims rejected either at the Clearinghouse level or at the Payer level.
Action Icons
Track Status: Tracks the claim status, such as the number of times the claim was sent, rejected, and reopened.
Claim Notes: It is used to write notes about the claim for internal documentation purposes.
Option PRI: Displays all the primary insurance claims (as mentioned during patient registration) that have been rejected or returned either at the clearinghouse 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 clearinghouse level or the payer level.
Note: PRI/SEC is a radio button selection; therefore, only one option can be chosen at a time.
Filter: The user can apply a Filter on the following fields to build the list accordingly by selecting one of the following filters and clicking the 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 by entering the appropriate value in the empty text box placed next to the drop-down: Filter and clicking the 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 the patient.
Provider: Name of the provider.
Insurance: Name of the insurance.
Batch No: Batch number of the claim submitted.
Status: The Claim Tracking Status Code is a hyperlinked status code that invokes the 'EDI Claim Current Status' pop-up. It is possible for a user to change the current status of the rejected claim and replace it with a more appropriate status code by selecting the appropriate status on the 'EDI Claim Current Status' pop-up. The new status for the rejected claim is retained once it is saved using the 'Save' button.
Note:
- When the user modifies the claim track status and clicks OK, the corresponding claim row on the Claims > Returned list will immediately reflect the new status in the hyperlink, along with the corresponding legend in its tooltip. The user can continue to change the claim track status for more than one claim by using the pop-up.
- The modified claim track status for such claims will be lost if the user does not click the Save action button at the bottom of the unpaid claims list. After modifying the claim track status code, a user needs to click the Save action button near the end of the returned claims list and then click Re-process to process the modified claims.
Send Date: Date on which the claim was sent by EDI.
EDI Error: Hyperlinked EDI Error Comment. The user can click the hyperlink to view the claim rejection details. The pop-up also allows the user to input his/her own comment about the rejection reason, which is then displayed as hyperlinked under the error column on this screen.
Charge: The claim amount billed to the insurance.
Hyperlinked columns allow sorting when clicked. These columns are:
- DOS
- Patient Display Name
- Provider Display Name
- Insurance Name
- Batch No
- Status
- Send Date
Count: It is the total number of PRI/SEC rejected claims displayed on the Returned screen.
Total: It is the sum total of the total billed amount for claims rejected by insurance companies for Primary/Secondary claims, according to the radio button selection for PRI/SEC.
Save: The 'Save' button retains the changes made to the status of the selected claim.
Re-process: The 'Re-process' button enables rejected claims to be reprocessed after changing them to the appropriate status using the 'EDI Claim Current Status' pop-up invoked upon clicking the hyperlinked status code.