Real-Time Claim Status

Real-Time Claim Status

*This is a Premium Add-on feature.

Common Problems with manually checking Claim Status

  • Challenge of timely follow-up on Insurance Claims that are delayed or have no response from the Payer.

  • A Claim can appear to be Payer Accepted, but the Claim has not yet been adjudicated.

    • If the Payer is contacted, the Claim will not be on file until it is adjudicated.

  • The manual process for checking a Claim's status is extremely time-consuming, costing valuable User productivity for your practice.

    • Long hold times

    • Navigating IVR systems

    • Inquiries on many different Payer portals that have short password expirations.

    • Lock outs for bad login attempts.

  • The result is lost revenue.


Advantages of using Real-Time Claim Status 

  • Real-Time Claim Status (RTCS) is an electronic method of getting an immediate Claim Status update from the Payer. If the Claim shows a Status of Payer Accepted on the Encounter Dashboard and the Payer offers RTCS, the option Check with Payer link will be available for checking Real-Time Claim Status. (Encounter Dashboard > Policy Breakdown panel > Insurance line > Check with Payer)
  • Since the Claim has reached adjudication, there will be no wasted User time contacting the Payer before adjudication.
  • The Last Checked Date makes it easy to view the last Claim Status results and should also help prevent unnecessary Real-Time Claim Status checks.
  • When RTCS is used, the exact same information that was sent in Claim Loop 2010AA will automatically be sent on the Claim Status Request.
  • This is EIN/SSN and NPI of the entity to whom the Insurance Payment is directed.
  • It ensures proper matching and response from the Payer.
  • This information is required whether checking Claim Status using RTCS or manually checking.
  • Real-Time Claim Status can be configured to run automatically using the Job Scheduler, eliminating the need for User intervention.


Payers with Real-Time Claim Status

On the Enrollment screen and the Clearinghouse Payer List, you can view a list of Payers that offer Real-Time Claim Status.

  • Home Dashboard > Enrollments button
  • To see the ones that need Enrollments to be completed, select Only for Enrollment Required (scroll to the right). Select Search.
  • To see all of the Payers that offer Real-Time Claim Status, select Include for Enrollment Required. Select Search.
  • The Action column will display whether the Payer requires Enrollment.

  • Admin > Clearinghouse Payer List button
  • Select Claims Status for Type.
  • This will produce a list of all Payers with Real-Time Claim Status along with Payer ID and the State designation if applicable.
  • To see only the ones that need Enrollments, select Claim Status for Type, and Yes for Enrollment Required. Select Search.
  • To see Enrollments for your State only, select Claim Status for Type, Yes for Enrollment Required, and select your State in the State filter. Select Search.
  • Enrollments must be done from the Enrollments button on the Home Dashboard.


Learn More