How do I monitor claims that need attention?
On a monthly basis, we recommend reviewing older claims that you should have received payment on.
Use the treatment date filters to select the time period you would like to check eg the first to last day of a particular month.
Use the claim status filter to only show claims that are marked as 'Needs attention' or 'Pending'.
Review each claim and determine next steps. You can refine the search further - filter by insurance status and follow the recommended actions below:
Insurance status | Questions to ask | Action if yes |
Rejected | Was the invoice deleted and a new claim created? | Discard (we suggest leaving a comment about why you are discarding) |
| Was it not covered by insurance so the patient paid? (Invoice status is 'Paid'). | Discard (we suggest leaving a comment about why you are discarding) |
| Does it need to be resubmitted? (The invoice status will be 'Unpaid' and no other claims will be related to that invoice). | Determine why it was rejected or what the error was. Make the change and resubmit, or mark as manually submitted. |
Error | Was the invoice deleted and a new claim created? | Discard (we suggest leaving a comment about why you are discarding) |
| Was it not covered by insurance so the patient paid? (Invoice status is 'Paid'). | Discard (we suggest leaving a comment about why you are discarding) |
| Does it need to be resubmitted? (The invoice status will be 'Unpaid' and no other claims will be related to that invoice). | Determine why it was rejected or what the error was. Make the change and resubmit. |
Submit manually | Was the invoice deleted and a new claim created? | Mark as manually submitted, then mark as reversed. |
| Was it paid? | If there is a payment, then mark as paid. |
| Are you waiting on insurance to pay? | Follow up with insurance, leave a comment and mark as submitted manually. |
| Was it not sent? | Resend the claim manually, mark as submitted manually. |
| Was it rejected? | Discard (we suggest leaving a comment about why you are discarding) |
Submitted manually Acknowledged EOB received | Was it paid? | If there is a payment from insurance, then show as paid by using the 'Record payment' button and entering $0.00. Ensure the payment is properly explained. |
| Are you waiting on insurance to pay? | Follow up with insurance and leave a comment. |
| Was it rejected? | Discard (we suggest leaving a comment about why you are discarding) |