Non-Apex: Resubmit Claim that has been Marked as Paid

 Permissions: You must have Billing Permissions with the ability to "Submit Claims to Clearinghouse" enabled.

This workflow is only for Non-Apex users. For Apex see: Resubmit Marked as Paid Claim workflow.

Check and Set EDI File Settings

To resubmit a corrected claim that has been marked Paid in TheraNest, EDI File Settings for the payer must include resubmission details.

IMPORTANT: This must be done prior to resubmitting the claim. 

1. Click Billing tab in primary navigation bar.
2. Click Insurers in side menu.
3. Click Edit for appropriate Insurer.
4. In EDI File Settings, select Ask for resubmission details prior to Re-Submit failed Claim.
   
5. Save changes.

Change Status for Failed/Rejected and Resubmit

1. Click Billing from the Primary Navigation Bar.
2. Choose Claims on the side menu.
3. Click Paid tab and locate appropriate claim.
4. Click Back to Submitted. This moves the claim to the Submitted tab.
5. Click on the Submitted tab and locate your claim - Click Status - Failed/Rejected.
6. Correct the error in the Client’s Profile or Invoice and Save updates made.
7. Return to Billing > Claims > Submitted and locate your claim.
8. Find your claim, click Status and select Resubmitted.
9. Choose the appropriate option from the drop down:
   7 = Replacement of a prior claim (Corrected Claim)
   8 = Void/cancel of prior a claim
10. 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.
    

11. Click Resubmit & Create New Claim.

The resubmission details you input will appear in Loop 2300 of the EDI file and Box 22 of form CMS1500. It looks like this: