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Correcting Claims

Version 14.19

Overview

This article will teach you how to edit an archived claim in order to submit a corrected claim to an insurance carrier.

Correcting Claims

  1. From the Clinical, Billing, or Practice Management tab, click the Patient Chart button.
  2. Search for and select the Patient.
  3. Click Claims.
  4. Select the Claim that needs to be corrected.
  5. Expand the claim by clicking + to the left of the Claim Date
  6. Select the line that needs to be edited and click the Edit button. The Edit Archived Claim Transactions window is displayed.
  7. Click the Other Items (1-27) tab.
  8. Look at the Payer claim ID field:
  • If the Payer claim ID field is populated with the payer's original claim number, click the Resub button and confirm that you want to prepare the Claim for resubmission. This will place that claim number in the Original reference or trans # field and a 7 in the Item 22: Medicaid resub code field. This must be done for all claim lines.
  • If the Payer claim ID field is blank or the claim batch number shows here, remove the batch number and enter the payer's claim number. Then, click the Resub button. This must be done for all claim lines.

WarningItem 22: Resubmission code 7 and Original Ref. No. must be present on all CPT claim lines in order for the corrected claim information to appear on the electronic claim or paper claim resubmission. Failure to populate these fields on all claim lines will likely result in the claim being denied as a duplicate by the insurance payer.

If edits are made to a claim prior to clicking the Resub button, you will receive a confirmation window asking if you would like to mark the claim corrected and send it to the queue. Select the Yes button to queue the corrected claim or No if you have not yet completed your edits.

  1. Click the Edit button  to make your edit to the appropriate line item.
  2. Locate the Field that needs to be edited.

NoteAll tabs of the window contain editable fields. Editing certain fields may change the structure of the Claim and could make the Claim appear as current. These edits include: the date or service, any provider on the claim, any CPT code, or any Unit Charge on the claim. See the lists below of what can be edited from each tab:

  • Summary: Charges vs Payments: NDC Number, CPT Modifiers, Units, Charge Amounts, EPSDT, and Referral values.
  • Basic Information: Rendered by and Billing Provider, Date of Service, DX Codes (after editing a dx code on this tab, you will need to associate it to the proper CPT line in the Summary: Charges vs Payments tab), and Location.
  • Other Items (1-27): Comp case details, Other dates related to injury, Referring or Ordering Providers, and any other specific claim fields designated by the payers.
  • Institutional (837I) Items: All items related to Hospital Facility billing.

Once edits are complete, click the Save buttonto save and close the Edit Archived Claim Transactions window. This may cause the edited Claim Line to be voided and replaced with the new information. The corrected Claim will be sent to the Transmit Queue. If you wish to print the Claim, click the CMS-1500 button when you have returned to the Claims window of the Patient Chart.

Version 14.10

Overview

This article will teach you how to edit an archived Claim in order to submit a corrected Claim to an insurance carrier.

Correcting Claims

  1. From the Smart Toolbar, click the Acct button.
  2. Search for and select the Patient.
  3. Click the Claims tab.
  4. Select the Claim that needs to be corrected.
  5. Expand the Claim by clicking the Expand Claim button (to the left of the Claim Date
  6. Select the Line that needs to be edited and click on the Edit button.
  7. The Edit Archived Claim Transactions window will open.
  8. Navigate to the Other Items (1-27) tab.
  9. Look at the Payer claim ID field:
  • If the Payer claim ID field is populated with the payer's original claim number, click the Resubmit (Resub) button and confirm that you want to prepare the Claim for resubmission. This will place that Claim Number in the Original reference or trans # field and a 7 in the Item 22: Medicaid resub code field. This must be done for all claim lines.
  • If the Payer claim ID field is blank or the OP 14 batch number shows here, remove the batch number and enter the payer's Claim Number. Then, click the Resub button. This must be done for all Claim Lines.
Note: Item 22: Resubmission code 7 and Original Ref. No. must be present on all CPT claim lines in order for the corrected claim information to appear on the electronic claim or paper claim resubmission. Failure to populate these fields on all claim lines will likely result in the claim being denied as a duplicate by the insurance payer. 

If edits are made to a Claim prior to clicking the Resub button, a confirmation window is displayed to ask if you would like to mark the claim corrected and send it to the queue. Select the Yes button to queue the corrected claim or No if you have not yet completed your edits.

  1. Click the Edit button to begin your edits to the appropriate line item.
  2. Locate the Field that needs to be edited.
Note: All Tabs of the window contain editable fields. Editing certain fields may change the structure of the Claim and could make the Claim appear as current. These edits include: the date or service, any provider on the claim, any CPT code, or any Unit Charge on the Claim. See the lists below of what can be edited from each Tab:
  • Summary: Charges vs Payments: NDC Number, CPT Modifiers, Units, Charge Amounts, EPSDT, and Referral values.
  • Basic Information: Rendered by and Billing Provider, Date of Service, DX Codes (after editing a dx code on this tab, you will need to associate it to the proper CPT line in the Summary: Charges vs Payments tab), and Location.
  • Other Items (1-27): Comp case details, Other dates related to injury, Referring or Ordering Providers, and any other specific claim fields designated by the payers.
  • Institutional (837I) Items: all items related to Hospital Facility billing.
  1. Once edits are complete, click the green checkmark button to save and close the Edit Archived Claim Transactions window. This may cause the edited Claim Line to be voided and replaced with the new information. The corrected Claim will be sent to the Transmit Queue. If you wish to print the Claim, click the CMS-1500 button when you have returned to the Claims window of the patient account.
Note: If the insurance on the Claim needs to be updated to a new payer, please see the Change Insurance on a Daysheeted Claim article.