Edit Claims

There are several methods for editing claims in the system; and much will depend on where the claim is in the claim cycle, and what works best for you at any given time.

We will discuss some of the recommended methods below.

For a single claim generated from an approved encounter but not yet submitted to the clearinghouse or mailed to the payer:

From the claims browser, locate and open the claim. Make changes to the claim as necessary. Note that if any changes need to be made to the patient or case record associated with the claim, you can double-click on the hyperlink in either field to open the corresponding record. Once you edit and save the record, you will be automatically returned to the open claim. Be sure to save the claim once all changes have been made.

For multiple claims generated by a single encounter but not yet submitted to the clearinghouse or mailed to the payer:

The easiest and safest way to correct multiple claims generated by a single encounter is to access the original encounter record, and unapprove the encounter (which deletes all claims associated with the encounter). Once you make the necessary changes to the encounter record or any other record associated with the encounter, you will then re-approve the encounter. This will create a whole new set of claims to replace the claims that were just deleted.

To open an encounter record from any open claim, double-click on the hyperlink in the Encounter field of the claim.

For claims previously submitted electronically and rejected by the clearinghouse, payer, or Kareo:

The best way to manage rejected claims is through the Clearinghouse Reports task. The "Claim Processing" tab of the Clearinghouse Reports task contains a list of all unreviewed daily claim reports, internal validation reports, and payer responses. Within these reports, you can easily identify the claims that have been rejected due to claim errors. Each rejected claim provides an explanation for the rejection and a link to the original encounter record.

Follow these steps to locate and correct rejected claims:

1. On the Encounters menu, click Clearinghouse Reports. This opens the Find Clearinghouse Reports task (or browser).

2. Click the "Claim Processing" tab.

Note that under the "Claim Processing" tab, there are three types of reports. The "Notes" column on the far right of the browser indicates the report type: Clearinghouse Daily (these are MedAvant and Gateway reports), Payor Daily (these are payer reports); and Kareo Internal Validation reports. The "Claims" column indicates how many claims are included in each report; and the "Rejected" column indicates how many rejections are included in each report.

3. Open any report that shows rejected claims. Once the report is open, you will be able to easily identify which claims have been rejected. Rejections are always indicated in red, and include the patient's name and the reason for the rejection.

4. To make corrections to one or more claims associated with the encounter, do the following:

Click on the encounter ID to open the encounter record. If the error is within the encounter record, edit the encounter as necessary.
If any changes need to be made to the patient or case record associated with the encounter, double-click on the hyperlink in either field to open the corresponding record. Once you edit and save the patient or case record, you will be automatically returned to the encounter record.

5. To rebill the claims associated with the encounter, do the following:

Click the Show Claims button at the bottom of the encounter record. This opens the claims browser displaying all claims associated with the encounter.
Right click anywhere within the list area to display the Action menu.
Select "Rebill" to open the Transaction screen.
Click Apply on the right of the Transaction screen. Note that a message will appear asking if you would like to rebill all claims associated with the encounter. Clicking Yes will reset all claims to Ready status. Clicking No will reset only the selected claim.

Note that at the top of the Clearinghouse Reports task, there is a link that allows you to download a guide entitled "Troubleshooting Rejected Claims." This guide goes into greater detail on where to go within the system to correct claims, and also provides a list of the most common clearinghouse, payer, and Kareo rejections.