Billing Claim Error Tab

The Claim Error tab displays claim rejection information returned after the claim was submitted. The error can be resolved, ignored (if allowed), or deleted, and the claim agent can be updated. The Error field lists the error description, the Status dropdown lists the error’s current status, and the Claim Agent dropdown lists the assigned claim agent.

The Claim Error tab is used to review and work claim events to resolve issues with claim processing. Rejected claim events are returned by the clearinghouse and/or intermediary and routed to specific claim agents to be worked.

Claim events can be resolved, ignored, or deleted. When all events for a claim are resolved, a new bill is created and sent via the Billing Service, and a system-generated note stating the claim was resolved is placed on the visit. Ignored events produce new claims that pass further edits with the clearinghouse/intermediary, while deleted claim events are removed without producing a new claim.

A resolution path, which lists step-by-step instructions to resolve the claim event, will display when selecting a claim event. The resolution path guides the user in updating data in the system, resolving the issue for this claim and all future claims as well. A claim event can also be reassigned to another claim agent.

Keep in mind that some claim events are merely informational, and they can be resolved with no other action. If substantial changes are being made, such as changing the primary insurance, the bill may need to be annulled.

To update a claim’s status or reassign the claim, follow these steps:

1. Status – Click the dropdown and select from the following:
   • Resolve – Select to resolve the event. The claim is resubmitted to billing.
   • Delete – Select to delete the event. If there are no other pending events for the selected claim and at least one claim event has been resolved or ignored, the claim will be resubmitted to billing.
   • Ignore – Select to ignore the event. If there are no other pending events for the selected claim, the claim will be resubmitted to billing to produce a claim with a note indicating the claim can be released to the payer. The claim event must be configured to be ignorable.

2. Claim Agent – Click the dropdown and select a different claim agent. As long as the claim event is still pending, it will be assigned to the claim agent.
3. Click Save.

Work Multiple Claims from the Work Queue Results List

If using a work queue that is set up with the multi-select option, such as the Rejected Claim queue in Billing, you can resolve, delete, or ignore multiple claim errors. If a work queue is set up with the multi-select option, the work queue results will have check boxes in the far left column. To work with multiple claim errors, follow these steps:

1. In the work queue results list, click the checkbox for each claim error.
2. Right+click and select an option.

The claim information and the work queue are updated.

Claim Error Notes

The Claim Error Notes tab displays a detailed history of notes for the specific claim event. Event notes must be entered prior to resolving, deleting, or ignoring an event, and they can be helpful for other users who work the same event in the future.

To add a note, follow these steps:

1. Click the Add button . A row is added to the Claim Error Notes list with the current date, user adding the note, and the Claim Note Information fields enabled.

2. Enter note information using one the following options:
   • Coded note. Enter a note code in the first field or a note description in the autocomplete field (clicking a suggested description to select it).

• • Free-form note. Enter free-form note text into the Narrative field.

The information populates the list.

You can only delete a note prior to saving it. Click the Delete  button. The note is removed.

3. Click Save.

Error Relevant Notes

The Error Relevant Notes tab displays all notes for other claim events that have the same event code as the currently selected event. The notes are specific to a claim event and could be helpful to other users who work the same claim event in the future.