After sending (or resending) electronic claims from the Billing Module, the Electronic Module must be reviewed in order to know if those claims were accepted or rejected. When claims are rejected they can be corrected and re-sent from the Electronic Module. This article will cover how to review batch reports.
Electronic Claim Batch Reports
- Status 'Sent': As soon as the claim is sent electronically from the Billing Module, the status in the Electronic Module will be 'Sent'. At some point, the exact amount of time varies, the status will change to one of the following statuses. If the status of 'Sent' remains after 12-24 hours, resend the claim.
- Status 'ERROR': If the status changes from 'Sent' to 'Error', click on the Batch link to see which claim has an error. This status typically stems from a bad internet connection or some other temporary issue. Resend the claim & it should transmit properly. However, if the status shows 'Error' again, try to determine what the issue is and if you are unsure, send a ticket onto the Procentive Help Desk for assistance.
- Status 'Received': When the status changes to 'Received', this means that the clearinghouse has received the claim. This status isn't confirmed for 3 days. Within those 3 days, the clearinghouse may change this status after further reviewing the claim.
- Status 'Has Rejections': If the status changes to 'Has Rejections', there is at least one DOS for a client that has an error on it and the clearinghouse has rejected it & the claim hasn't been sent on to the payer. To see which client & DOS has an error, click on the Batch link.
- Batch link: This will take you to the Reports section of the claim & will list the client, DOS & status of the claim. This is where you will see why a specific claim has been rejected or that the claim was accepted. To review the actual claim & the information sent on it, click the radio button in front of X12 Summary or X12 Detail.
- X12 Summary provides information on the claim in a easily readable format.
- X12 Detail provides the same information as the X12 Summary but in a more detailed, technical format.
- Raw provides the very technical coding of the claim.
- Reviewed: After waiting 3 days after sending the claims & you have reviewed the acceptance/rejection reports in the Batch link for each invoice, you will want to mark the invoice as 'Reviewed' by putting a check in the box in the 'Reviewed' column.
- If you fail to take this step, it will be very difficult to know for certain (as time passes) which claims have been reviewed and which haven't.
- 'Has Rejections' claims: Wait to mark the reviewed box until you have resolved the cause of the rejection AND resent the rejected claims.
- If no report appears after 24 hours when you click on the Batch link, contact the Procentive Help Desk for assistance.
- For steps on how to resend claims, see article Resend a Claim.