Rejected Claims on the Encounter by Status Panel
Three Categories of Rejections
These Rejections are found in the Encounter by Status Panel on the Claims Management Dashboard or Home Dashboard if pinned.
Local Edit Errors (LE)
- The Local Edit Errors are System delivered rules to catch specific problems before the Claims are sent to the Clearinghouse. Local Edit Errors can also be created by the User in Charge Management.
Clearinghouse Rejections (CE)
- Clearinghouse Rejections are System delivered edits by the Clearinghouse (EDI). These rejections should be expected.
- The rejections allow you to correct and resubmit clean Claims to the Clearinghouse before being sent to the Payer.
- Since Claims are processed within minutes of uploading a Claim Batch. Clearinghouse Rejections arrive quickly and should be worked soon to prevent Claim submission delays to the Payers.
Payer Rejections (PE)
- Payers are not required to meet a specific standard for their Claims response.
- The biller or coder will need to research which may require the User to contact the Payer directly for more information to understand the reason for the Rejection
- The rejections allow you to correct and resubmit Claims to produce clean Claims to the Payers.
Work the Rejected Claims
On the Encounter by Status panel, click the number to the right of the Rejection Status to access additional Filter Criteria and to view and work the Claims that were Rejected.
Hover over the Reason to see the entire Rejection/Error Message.
Select the Encounter number to Modify the Encounter.