Electronic Claim History: Claim Status and Rejected Claims

Practices that submit electronic claims should frequently check the Electronic Claim History to review claim rejections from the clearinghouse or payer.

Locate Rejected Electronic Claims

There are several ways to get to the Electronic Claim History page in TherapyNotes.

1. Click Patients > Patient name > Billing tab. The claim's Insurance Status appears as Pending Resubmit.

2. TherapyNotes keeps count of rejected electronic claims in several locations with a link and a blue bubble with a number in it. The number in the bubble indicates the number of rejected claims.

Navigate to the Electronic Claim History screen

There are several ways to get to the Electronic Claim History page in TherapyNotes.

Option 1: Click To-Do > Review electronic claim rejections

Option 2: Click Billing > Electronic Claim History

Option 3: Click Patients > Patient name > Billing tab > Electronic Claim History

Option 4: Click Payers > Payer name > Billing tab > Electronic Claim History

Filter Electronic Claim History

Once on the Electronic Claim History screen, you can perform a search, click on the status or claim to get more information, and leave comments on each claim.

1) Search Type. The Electronic Claim History page automatically defaults to the Quick Search view. To quickly view newly rejected claims, click the Rejections to Review button. To perform a custom search, click the Custom button.

2) Search Fields. Configure the Payer, Patient, Clinician, Claim Status, Claim Date, and Claim Number fields to run a custom search through your submitted electronic claims, then click the Search Claims button.

To view rejected claims that have been marked as processed, click the Custom button, change the Claim Status dropdown to Rejected, configure other desired fields, then click Search Claims.

3) Claim History. To get into the history for a particular claim, either click the Claim Number on the left, or the Status on the right The statuses include:

Submitted - The claim has been submitted through TherapyNotes to the clearinghouse.
Sent - The claim has been sent from the clearinghouse to the payer.
Resubmitted - The user has submitted a claim to the clearinghouse that has already been submitted at least once.
Rejected - Either the clearinghouse or the payer has rejected the claim, and the claim has been marked as reviewed.
Rejected - New - Either the clearinghouse or the payer has rejected the claim, and it has not yet been marked as reviewed.
Paid - Your practice has entered an allocated an insurance payment into TherapyNotes

4) Comments. Any comments on the claim appear as a yellow note icon in the far right column. Hover over the icon to see the most recent comment, or click the icon to view the comments.

View Rejected Claim

Click on the status or claim number as noted above to jump to the Claim History and Claim Details.

1) Claim Information: This contains the TherapyNotes claim ID, insurance status, date of service, patient, clinicians, and total amount billed.

2) Biller Comments: Leave any comments about the claim here. For example, leave notes about calling the payer to inquire about the rejected claim, and what actions need to be taken before resubmitting the claim.

3) Claim History: This section contains all messages sent from the clearinghouse or payer about transmission, acceptance, and rejection.

4) Submitted: The time and date stamp shows when the claim was transmitted electronically from TherapyNotes to the clearinghouse.

5) Update from Clearinghouse / Payer: The clearinghouse or payer sends a message with a time and date stamp to record when the claim was accepted for processing.

6) Rejected by Clearinghouse / Payer: If the clearinghouse or payer rejects the claim, this message appears.

Note: Not all payers report electronic claims rejections through TherapyNotes. To find the reporting level for your payer, click Payers > Payers Supported by Clearinghouse text link at bottom right of the page. Enter a payer name and search the database. In the blue header, hover over the "Reports" column to see what information the payer reports.

7) Rejection Message: Any rejection message from the clearinghouse or payer appears.

If you need help figuring out what went wrong or how to fix it, contact the support team with your Practice Code and the TherapyNotes claim ID at support@therapynotes.com or 215-658-4550. Although the support team can help with many claim rejections, sometimes you will need to contact the payer directly to inquire about how to fix the rejected claim.

Claim Details

This section includes the information that was transmitted via the electronic claim.

8) Practice Information: This information is located under User Icon > Settings > Practice Information. If a Clinician Billing Setting Override is turned on for the payer, the information is located under Staff > Staff user > Billing tab > Clinician Billing Setting Overrides.

9) Practice Billing Contact: This information is either located under either User Icon > Settings > Practice Information OR User Icon > Settings > Practice Billing > Alternate Billing Address.

10) Patient Information: This information is located under Patients > Patient name > Info tab.

11) Primary Insured Person: This information is located under Patients > Patient name > Billing Settings tab.

12) Primary Insurer: This information is located under Patients > Patient name > Billing Settings tab > Primary Insurance.

13) Line Items: This information comes from each billing line item that was batched onto the claim from Patients > Patient name > Billing tab.

14) Mark as Reviewed: Click this button to change the status from Rejected - New to Rejected. Doing so removes this rejected claim from the To-Do list notification of newly rejected electronic claims.

Resubmit Electronic Claims

Once you know why the claim was rejected, make the necessary changes in your TherapyNotes account, then resubmit the claim.

For a visual tutorial about resubmitting claims, read Resubmit Electronic Claims.