Submitting a corrected claim

The corrected claim workflow allows you to resubmit claims without having to first delete them. Instead, claims are archived, preserving a record of the original claim in your account while automatically creating a new one that you can edit and resubmit. 

In this guide, we’ll cover:

• Things to consider when submitting a corrected claim 
• When to delete a claim instead of correcting it 
• How to submit a corrected claim 
• Resolving claims submitted to the wrong payer 
• Reviewing a claim’s history 
• FAQs

Note: The new corrected claim workflow is being released in phases. If you don't see this feature in your account yet, it'll become available as the rollout continues.

Things to consider when submitting a corrected claim

A claim is considered processed when it’s moved past any initial scrub errors and reached the clearinghouse. Claims that are then rejected or denied can be resubmitted using the corrected claim workflow. You may also need to submit a corrected claim if: 

• You notice an error after the claim was submitted
• The insurance payer didn’t process the claim correctly

If a claim is Denied or meets one of the above criteria, we recommend contacting the payer before resubmitting it, as they may have unique requirements. Specifically, you’ll want to confirm how box 22 should be completed.

Some payers require that you mark the claim as a Resubmission and include the original claim’s payer number. While this is the most common way to resubmit denied claims, some payers require that all resubmissions be marked as Original instead. 

Note: Payers can’t assist with rejected claims, because they were rejected before reaching the payer’s database. If you know what needs to be corrected on a rejected claim, resubmit it as an Original in box 22. For more information, see Resolving rejected claims. 

When contacting the payer, provide them with the client’s insurance ID, the date(s) of service on the claim, and the billed amount so they can locate the claim and advise how it should be resubmitted.

When to delete a claim instead of correcting it

Claims that have successfully reached the clearinghouse can't be deleted. Instead, the corrected claim workflow archives the original claim and creates a new one that you can edit and resubmit.

Claims that are Prepared but not submitted, or claims that received Scrub errors before reaching the clearinghouse, can be deleted using the trash icon.

Claims in the following statuses can’t be deleted:

• Paid
• Denied
• Deductible
• Submitted
• Rejected
• Accepted
• Received

If a claim in one of these statuses needs to be resubmitted, use the corrected claim workflow.

How to submit a corrected claim

After confirming how the payer requires box 22 to be completed, submit a corrected claim by following these steps:  

1. Open the claim
2. Copy the Payer Claim # from the top of the claim 

• If the payer wants the claim resubmitted as an Original, or if the claim was Rejected, skip this step

3. Click Create Corrected Claim

4. Confirm which appointments should be included on the corrected claim, then click Continue

• Unless the payer specifically instructs you to exclude certain appointments, include the same dates of service as the original claim

5. Confirm that you’d like to archive the original claim

6. Make any necessary edits based on what needs to be corrected
7. Depending on the payer’s requirements, complete box 22 by: 

• Choosing Resubmission and pasting the original payer claim number in the Original reference number field, or
• Choosing Original and leaving the field blank

8. Return to the top of the claim and click Save
9. Submit the corrected claim

Once the corrected claim has been submitted, you can use the Claim dropdown next to the client’s name to view the resubmission and the archived original. 

Resolving claims submitted to the wrong payer

Claims submitted to the wrong payer are typically rejected or may remain in the Accepted status. This happens because the client’s insurance ID doesn’t match what the payer has on file, preventing the claim from being processed. 

Payer IDs can’t be edited when resubmitting a claim. Once you’ve confirmed that a claim was submitted to the wrong payer:

1.  Update the client’s insurance information in their profile
2.  Return to the claim
3.  Click Create Corrected Claim
4.  Follow the on-screen prompts to archive the original claim

This creates a new claim with the updated payer ID. If no other edits are needed, submit the claim as an Original in box 22.

Reviewing a claim’s history

As claims are resubmitted, you may need to reference their submission history. This can be helpful when following up with payers or documenting changes to a client’s insurance. 

You can review a claim’s history across the Status detail, History, and Claim notes tabs.

The Status detail tab shows payments received for the claim’s date(s) of service, either manually or through Electronic Payment Reports (ERAs). 

The payment and its Received link will appear across all versions of a claim so it can be easily accessed.

However, an ERA is only available in the Status detail tab of the claim that received it. This means an archived claim may contain an ERA that isn’t available from the most recently submitted version of the claim.  

Similarly, Claim notes and any notes saved there are specific to that version of the claim only.

Use the Claim dropdown next to the client’s name to open an archived claim and view its details and/or notes.

You can also review a claim’s History for its full submission timeline. There, you can see when a claim was archived and click the link to the original. 

FAQs

• Why can’t I delete claims anymore? 
• When should I use the corrected claim workflow? 
• Why can’t I edit a submitted claim?  

Why can’t I delete claims anymore?

If you don't see the trash icon, or can't delete a claim, it's because the claim has already reached the clearinghouse.

Before the corrected claim workflow was introduced, claims that needed to be resubmitted had to be deleted and recreated. Because deleted claims can't be restored, we also recommended downloading a copy of the claim and noting any associated clearinghouse or payer reference numbers before deleting it.

The corrected claim workflow preserves a record of any claim that has reached the clearinghouse by archiving it instead of deleting it. This makes it easier to reference submission history, payer claim numbers, and proof of timely filing when following up with insurance payers.

When should I use the corrected claim workflow?

You can use the corrected claim workflow to resubmit claims in any of the following statuses: 

• Paid
• Denied
• Deductible
• Rejected
• Accepted
• Received

Claims with the Scrub or Prepared status haven’t reached the clearinghouse and can be deleted before resubmitting them. 

For more information on claim statuses, see Understanding claim statuses. 

Why can’t I edit a submitted claim?

Claims in the Submitted status can’t be edited. This helps prevent duplicate submissions while the original claim is still being processed by the payer. 

If you need to make changes to a claim, wait until it moves past the Submitted status before submitting a corrected claim. 

If a claim appears to be stuck in the Submitted status, submit an email help request with the claim URL so we can investigate with the clearinghouse.