How To: Resubmit EDI Claims

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To resubmit an electronic (EDI) claim, make sure you make any necessary changes in TherapyNotes first.

 

This article overviews:

  • Locate Rejected EDI Claims
  • Get to the "Submit EDI Claims" screen
  • Resubmit EDI Claims
  • Track Claim Status with EDI Claim History
  • Enter Insurance Payments
  • Additional Resources

Locate Rejected EDI Claims

When an EDI claim rejection comes through TherapyNotes, the insurance status automatically switches to "Pending Resubmission". Under PATIENTS > Click patient > "Patient Billing" tab, the "Ins Status" changes to "Resubmit EDI" in green. The image below shows where to locate the insurance status under the "Patient Billing" tab.

 

Get to the "Submit EDI Claims" screen

First, get to the "Submit EDI Claims" screen through one of the following ways.

Option 1: Click TO-DO > "Submit EDI Claims" 

 

Option 2: Click BILLING > "Submit EDI Claims" 

 

Option 3: Click PATIENTS > Click patient > "Patient Billing" tab > "Submit EDI Claims"

 

Option 4: Click PATIENTS > Click patient > "Patient Billing" tab > "Resubmit EDI"

 

Option 5: Click PAYERS > Click payer > "Payer Billing" tab > "Submit EDI Claims" 

 

Option 6: Click the gray "Resubmit" button on the EDI Claim Details screen


Resubmit EDI Claims

 Status: The "Status" dropdown defaults to "Pending Initial Submission or Resubmission", however you can select another option.

  • Note: If you are looking for a claim that was submitted through TherapyNotes, rejected by the payer, but not set as "Rejected" in TherapyNotes, select the option "All Open Items".

 Payer: Either leave the default "Any Payer" or select another option from the dropdown.

 Clinician: Either leave the default "Any Clinician" or select another option from the dropdown.

 Patient: Either leave the default "Any Patient" or click the link "Select an Individual Patient".

 Appointments: The date range defaults to 1 year in the past, however you can enter another date.

 Check off Dates of Service: Check off the dates of service you want to batch onto the claim.

  • Note: Claims are batched by patient. Conditions such as pre-authorizations can split the batched claim of a patient into multiple claims.

 Resubmission Type: Select an option from the dropdown.

  • "New Claim" means a newly resubmitted claim.
  • "Amended Claim" means a corrected claim. Selecting this option puts the number 7 on the corrected claim.
  • "Void Claim" should be used when the payer asks for a voided claim. 

 Payer Claim Control Number: If the payer asked you to resubmit the claim using a claim control number, enter it here. Contact the payer directly to obtain a claim control number. Claim control numbers are optional for "New Claim" and required for "Amended Claim" and "Void Claim".

 Review Claim Details: If you want to see exactly what is on the claim before submission, click "Review Claim Details".

 Submit Claims: After checking off the dates of service to resubmit, click the green "Submit Claims" button to send the claims to the clearinghouse.

 


Track Claim Status with EDI Claim History

After resubmitting the claims, track the status with the EDI Claim History.  

  • For a visual tutorial about how to track claim status with EDI Claim History, see this article.

Enter Insurance Payments

Once you receive the explanation of benefits (EOB) or electronic remittance advice (ERA) and the insurance payment, post it to TherapyNotes.

  • For a visual tutorial of how to use Assisted ERA Payment Posting feature, see this article
  • For a visual tutorial of how to enter insurance payments, see this article.

Additional Resources:

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