Claim FAQs

Claim FAQs

Claims Stuck

Why are Claims stuck in the status of Ready for Submission?

Claims are stuck in Ready for Submission

Examples:
  1. The most common reason is that the Reference Batch is not closed.
    1. It will be listed in the Claims Submission Queue as Open Reference Batch.
      1. If it is still open, it must be closed before the Claims in that Reference Batch will be batched.
    2. On the Encounter Dashboard, the Padlock icon in the Charge panel should display as locked.

  1. The Encounter has a Credit Balance.
  2. Adjudication Unbalanced: The posting from the previous Payer is not balanced.

  1. Are all Tags resolved that may be holding the Claim?
    1. A Claim will not batch if it has an unresolved Tag.
    2. When the Tag is resolved, the Claim will batch on the next run.

 Claim Status

What Claim Statuses are eligible to be batched, uploaded, and submitted to the Clearinghouse?

Claims Statuses that are eligible to be uploaded or submitted to the Clearinghouse

  • IP03: READY FOR SUBMISSION

  • IP04: READY FOR RESUBMISSION

  • IP06: READY FOR SUBMISSION ZERO BALANCE

    • This status indicates that the User has set an Encounter to resubmit that currently has a zero balance.  

HCFA (Paper Claim)

Why is HCFA box 33 blank?

HCFA (Paper Claim) Box 33 is Blank

  • From Libraries on the Left Side Menu, select Billing/Pay To Location. The Block Address must be populated. Select Copy to populate the Block Address.
  • Check that the Facility has the Block Address selected. 
  • Check that no ID or Cross Codes are setup on the Insurance or Provider to intentionally leave this area blank. 

Insurance Library

Is the Insurance Library Setup Correctly?

Check the Insurance Library for:

  1. Form Type: Is for Electronic Submission selected?
  2. Payer ID: Is the Payer ID missing?

Zero Balance

Encounter has a Zero balance and the Claim Status is not IP06 (Ready for Submission Zero Balance)
Encounter has a zero balance but is not IP06
  • By Default, the System will not batch Zero-Balance Encounters.
  • To submit the Claim, override the Default by changing the Claim Status to Ready for Submission/Resubmission.
  • The Claim Status will show on the Encounter as Ready for Submission Zero Balance.

 

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