This workflow is only for Non-Apex users. Click here for Apex workflow.
To resubmit claims there are a number of steps:
Check and Set EDI File Settings
To send a corrected claim (populate box 22 with the original claim number) EDI File Settings must include resubmission details.
IMPORTANT: This must be done prior to resubmitting the claim.
- Click Billing tab in primary navigation bar.
- Click Insurers in side menu.
- Click Edit for appropriate Insurer.
- In EDI File Settings, select Ask for resubmission details prior to Re-Submit failed Claim.
- Save Changes.
Mark the Claim as Failed/Rejected
- Click Billing tab in primary navigation bar.
- Click Claims in side menu.
- Click Submitted tab to show all Claims submitted in the last month.
- Filter the Date Range if needed.
- Click Status and select Failed/Rejected.
Correct the Error and Resubmit
You must correct the error in the original claim either through the Client Profile or original Invoice.
- Correct the error in the Client Profile or Invoice and Save.
- Return to Billing > Claims. Select Submitted tab.
- Find your claim, click Status and select Resubmitted.
- Choose the appropriate option from the drop down:
7 = Replacement of a prior claim (Corrected Claim)
8 = Void/cancel of prior a claim - Enter Original Reference Number (This is the Payer Claim Number)
NOTE: You must have the Payer Claim Number/Original Reference Number filled in order to resubmit a corrected claim.
If you do not enter the Original Reference Number you will Receive an error.
- Click Resubmit & Create New Claim.
NOTE: If you are resubmitting this Claim for a second or third time, you will have the option to make the Claim as Resubmitted without creating a New Claim. This will not send a claim to the clearinghouse and only update the status in TheraNest.
The resubmission details you input will appear in Loop 2300 of the EDI file and Box 22 of form CMS1500. It looks like this:
