Claim Sent in Error

Claim Sent in Error


A Claim might have been created on the wrong Patient or it might have had the wrong Date of Service (DOS).


Claim Not Sent to Payer

In Open Period with No Posted Payments

  • The Encounter can be made Incomplete and Deleted if there are no Payments posted, such as a Copay.

In Closed Period with No Posted Payments

  • The Encounter can be Reversed for Deletion if there are no posted Payments.

In Open or Closed Period with Posted Copay/Patient Payment

  • If there is a posted Copay/Patient Payment:
  • Refund the Patient.
  • Use an existing or custom Adjustment Code to write-off the Charge Amount.
  • Using a custom Adjustment Code identifies it from other Adjustments.


Claim Sent to Payer

Claim Has Not Yet Adjudicated

The Claim was sent to the Payer, but it has not yet been adjudicated.

  • Wait for the Payer to adjudicate the Claim before making changes to the Claim.
  • Do not Reverse the Charges before the Claim is adjudicated.
  • If the Payer pays the Claim, you will need the original Charges to post the Payment.
  • If the Claim is in an Open Period, the Line Item Fees can be changed to $0.00 before adjudication.


Claim Has Adjudicated

In Open or Closed Period without Payment (Denial)

  • If there was no Insurance Payment after adjudication or Patient Payment on the Claim, the Encounter can be Reversed for Deletion.

In Open Period with Payment

  • Before posting the adjudication transactions, the Line Item Fees on the Claim can be changed to $0.00.

In Open or Closed Period with Payment

  • Post the adjudication transactions from the Remit (Payments and Adjustments).
  • If the Payer does a full Takeback on a future ERA Remit, the Adjustments are needed to facilitate the posting of the ERA Takeback.
  • If you are sending the Refund by check to the Payer, the Adjustments are not necessary, but it is best to post them.
  • Post the Insurance Refund when you send the Refund check or when it is taken back on a Remit.
  • Depending on how the Payment was posted and how the Payer takes it back will determine the method used for posting the Takeback.
  • If there is a posted Patient Payment, post and send a Refund to the Patient.

In Closed Period after Refund is Processed

The goal is to get the Encounter Balance to zero.

  • After the Refund (Patient and Insurance) is posted, use an existing or custom Adjustment Code to write-off the Charges.
  • Using a custom Adjustment Code identifies it from other Adjustments.


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