Claim Actions

Claim actions are currently only available at the individual claim basis. To take one of the below available actions: navigate to the client's Claims screen or the Workflow Insurance screens mentioned above and select a claim's checkbox. Once selected, the actions panel will appear.

Create Claim

For more details on creating claims, see this article for a full breakdown.

 
 

View Details 

For all claim statuses, select the View Details action to open the review claim screen. Use this to reference the sessions and other billing codes submitted for a specific claim.

 
 

Void Claim

For any reason a user decides voiding a claim is necessary, this can be done by selecting the Void Claim action. This is available for Queued, Submitted, Rejected, and Paid Claims.

 
 

Edit/Resubmit Rejected Claims

For Claims that have been Rejected by a Clearinghouse, you have the option to Edit Claim and Resubmit from the Actions panel after reviewing Rejection reasons. Follow the Edit Claim prompts to fix any rejection reasons and resubmit the claim.

 
 

Create Replacement 

You can create a replacement for a denied claim that has been voided.  This new claim will be populated with the information from the original claim so you can easily make the needed adjustments.  

Note that the Submit Claim button will be grayed out and you will not be able to proceed until the information has been modified.

 
 

View Paid Claim Explanation of Benefits (EOB)

 For Adjudicated and Approved Claims, you can select the action to View EOB. This feature allows you to view the service details and review the Amount Billed for a service, the Insurance Adjustment amount, the Amount Paid by insurance, as well as the client's responsibility amount. 

You can download, print, or email the EOB from the left hand side of this view.  In the Email drop down menu, you can select and add recipients, as well as an attached message, and even add a password to the generated PDF for added security.

 
 

User Actions by Claim Status

The following is a table of actions you can take depending on the current claim status. Green check marks denote that an action can be taken under the given claims status, and red x marks denote that an action cannot be taken under said status.

Claim Status

Create Claim

Edit Claim

Void Claim

Create Replacement

View Details

View EOB

Ready to Submit

Check Mark
Cross Mark
Cross Mark
Cross Mark
Cross Mark
Cross Mark

Queued

Cross Mark
Cross Mark
Check Mark
Cross Mark
Check Mark
Cross Mark

Submitted

Cross Mark
Cross Mark
Cross Mark
Cross Mark
Check Mark
Cross Mark

Corrected

Cross Mark
Cross Mark
Check Mark
Cross Mark
Check Mark
Cross Mark

Rejected

Cross Mark
Check Mark
Check Mark
Cross Mark
Check Mark
Cross Mark

Approved

Cross Mark
Cross Mark
Cross Mark
Cross Mark
Check Mark
Check Mark

Deductible

Cross Mark
Cross Mark
Cross Mark
Cross Mark
Check Mark
Check Mark

Denied

Cross Mark
Check Mark
Check Mark
Cross Mark
Check Mark
Cross Mark

Voided

Cross Mark
Cross Mark
Cross Mark
Check Mark
Check Mark
Cross Mark

Replacement

Cross Mark
Cross Mark
Cross Mark
Cross Mark
Check Mark
Cross Mark
 
 

Acknowledgement Checkbox

Note that many claims actions require you to select the acknowledgement checkbox before proceeding with the action.  Unless you select this checkbox, the desired action will be grayed out and you will not be able to proceed.