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.
- 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.
Change Status for Failed/Rejected and Resubmit
- Click Billing from the Primary Navigation Bar.
- Choose Claims on the side menu.
- Click Paid tab and locate appropriate claim.
- Click Back to Submitted. This moves the claim to the Submitted tab.
- Click on the Submitted tab and locate your claim - Click Status - Failed/Rejected.
- Correct the error in the Client’s Profile or Invoice and Save updates made.
- Return to Billing > Claims > Submitted and locate your claim.
- 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.
The resubmission details you input will appear in Loop 2300 of the EDI file and Box 22 of form CMS1500. It looks like this: