This workflow is only for Non-Apex users. Click here for Apex: Resubmit Marked as Paid Claim workflow.
- Click Billing from the Primary Navigation Bar.
- Choose Claims on the side menu.
- Click Paid/Processed tab (if an ERA has been processed for this claim) and locate appropriate claim.
- Click Actions > Back to Submitted. This moves the claim to the Submitted tab.
- Correct the error in the Client’s Profile or Invoice and Save updates made.
- Return to Billing > Claims > Submitted > Mark as Failed/Rejected.
- Now click Update Status > Resubmitted.
- Resubmission Details window will appear and say “Choose appropriate option below..” but the first time resubmitting only one action is allowed and that is to click the button “Resubmit & Create new Claim”
If you need to send a corrected claim (populate box 22 with the original claim number) you will need to follow these instruction before you resubmit 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.
When resubmitting the claim a dialogue box will pop up asking you to choose the resubmission code and enter the original reference number for the claim.
Resubmission Code
- 7 - replacement of prior claim
- 8 - void/cancel of prior claim
Original Reference Number (you may need to call the insurance payer to get the Original Reference Number).
Resubmission details appear in Loop 2300 of the EDI file and Box 22 of form CMS1500:
