EDI Claim History: Claim Status and Rejected Claims
Practices that regularly submit electronic claims should frequently check the EDI Claim History to watch out for rejections from the clearinghouse or payer.
This article overviews:
- Locate Rejected EDI Claims
- Filter EDI Claim History
- View EDI Claim History
- Resubmit EDI Claims
Locate Rejected EDI Claims
TherapyNotes signals a rejected electronic claim through several means.
First, under PATIENTS > Click patient > "Patient Billing" tab, the claim's "Insurance Status" appears as "Resubmit EDI" in green.
Second, TherapyNotes keeps count of rejected EDI 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.
Get to the "EDI Claim History" screen
There are several ways to get to the EDI Claim History page in TherapyNotes.
Option 1: Click TO-DO > "Review EDI claim rejections"
Option 2: Click BILLING > “EDI Claim History”
Option 3: Click PATIENTS > Click patient > "Patient Billing" tab > "EDI Claim History"
Option 4: Click PAYERS > Click payer > "Payer Billing" tab > "EDI Claim History"
Filter EDI Claim History
Once on the EDI Claim History screen you can perform a search, click on the status or claim to get more information, and leave comments on each claim.
The EDI 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.
Configure these fields to run a custom search through your submitted EDI claims, then click the gray "Search Claims" button.
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.
Any comments left on the claim appear as a yellow icon. Hover over the icon to see the most recent comment, or click the icon to view the comments.
View EDI Claim History
Click on the status or claim number in step #8 above to jump to the Claim History and Claim Details.
Claim Information: This contains the TherapyNotes claim ID, insurance status, date of service, patient, clinicians, and total amount billed.
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.
Claim History: This section contains all messages sent from the clearinghouse or payer about transmission, acceptance, and rejection.
Submitted: The time and date stamp shows when the claim was transmitted electronically from TherapyNotes to the clearinghouse.
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.
Rejected by Clearinghouse / Payer: If the clearinghouse or payer rejects the claim, this message appears.
- Note: Not all payers report EDI rejections through TherapyNotes. To find the reporting level for your payer, go to PAYERS > "Payers Supported by Clearinghouse". Enter a payer name and search the database. In the blue header, hover over the "Reports" column to see what information the payer reports.
Rejection Message: Any rejection message from the clearinghouse or payer appears here.
- Note: 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 firstname.lastname@example.org 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.
This section includes the information that was transmitted via the electronic claim.
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 > Click staff user > "Billing" tab > "Clinician Billing Setting Overrides".
Practice Billing Contact: This information is either located under either User Icon > Settings > "Practice Information" or User Icon > Settings > "Practice Billing" > "Alternate Billing Address".
Patient Information: This information is located under PATIENTS > Click patient > "Patient Info" tab.
Primary Insured Person: This information is located under PATIENTS > Click patient > "Billing Settings" tab.
Primary Insurer: This information is located under PATIENTS > Click patient > "Billing Settings" tab > "Primary Insurance".
Line Items: This information comes from each billing line item that was batched onto the claim from PATIENTS > Click patient > "Patient Billing" tab.
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 EDI claims.
Resubmit EDI 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 how to resubmit EDI claims, see this article.