Hi, I'm Maggie, senior product manager for claim management here at SimplePractice. Today, I want to talk to you about our new corrected claim workflow. And I'm going to start by navigating over to our beautiful new Billing hub. We have our "dashboard" view where we've landed here, where we also have appointments, claims, and transactions. And based on our selected time range, our dashboard will highlight, first, our "outstanding items" as the highest priority tasks to take care of within billing. And then we're going to scroll down to this easy to access count of claims by status, and you can easily jump in to take a look at any claims that are paid, in progress, scrubbed, or denied and rejected. So for example, if we click "paid" here, it will take us to the "claims filed" page with a pre filtered view of all finalized paid claims. Otherwise, from the dashboard, we can navigate directly to claims and claims filed for the page that you are used to seeing. So there's two different actions we're gonna go through today. I'm going to talk about when to correct a claim and when to just edit a claim. We're going to start with editing a claim. So if a claim has not been submitted to the payer yet, we still give you the option to edit or delete that claim. For example, a claim that's an "action required," is a claim that we considered scrubbed. That means that an attempt to submit the claim was made, but it never made it out of our system because we caught an an error early. So the payer does not have any record of this claim yet. So in that case, we can make edits to this claim, and we don't need to create a brand new claim. So we'll go ahead and click edit in the top right corner here, and we can make any changes to this claim. Let's say we submitted it with the wrong member ID. We would update the member ID here. And when we click save, we would persist those changes to the client's record, and then we could submit this claim, without needing to go through the corrected claim workflow. When you need to correct the claim, it's usually because a claim has already been adjudicated by the payer. So that means that the claim went to the payer, and the the payer made a final decision about whether or not the claim should be paid or denied. So I have a couple of, examples of paid claims in my account here, and we'll pick this one here. A paid claim might need to be corrected for a number of reasons. Maybe we submitted the wrong date of service. Maybe we submitted the wrong procedure code or we submitted it to the wrong payer. In order to get this straightened out with the payer, we would need to submit a new claim. In the previous system, the recommendation was to save a copy of it for your records, delete the original claim, and then generate a brand new claim. What we've done instead is given you the option instead of deleting to archive that original claim. And to talk a little bit more about why we decided to build this new workflow, we found the previous guidance to be clunky and too manual. And we know that you're already managing a lot of manual workflows when it comes to insurance. Then the new ability to archive claims allows you to easily retain that record without having to risk completely getting rid of the original claim. And in the bigger picture, will allow us to eventually build more automations and more guidance for you along your insurance journey. So to get started, I'm going to go ahead and click this button here to create a corrected claim. When you click create corrected claim, you can expect a few pop ups here to guide you through the process so that you no longer need to keep track of everything on your own. So we'll give the option to select which appointments to include, and then we're also going to archive the current claim. And then we will effectively make a copy of the current claim, pulling in any updates that have been applied to the client's record. So now we have a brand new claim, and I want to pause for a moment to talk about box twenty two. So different payers have different requirements around the corrected claim workflow. Some payers will require that you first submit a cancellation claim with the original claim reference number. Other payers require that you submit it straight as a resubmission, in which case you'll pull in the original reference number, which I'm going to talk about in just a second. And other payers don't want a resubmission code at all. They just want this new claim with corrections on it submitted as a original claim. Medicare, for example, is a payer that usually requires that you submit a new claim as an original. I recommend talking to your payer and understanding what the requirements would be to get a new claim processed, and what's required. So let's say we submitted the wrong service code. So we'll want to go ahead and change this, and we're going to change it to a nine zero eight three seven. And let's increase our rate. Let's say we we charge the wrong amount. So I made those changes. Now I'll just click save. So before I submit this, I want to go back and confirm with the what the original claim reference number was. Within this new workflow, one really great feature is that we can toggle back and forth between the original claim that's now archived and our current claim. And up here in the upper left corner, you'll see a little arrow that you can click to see a drop down of claim versions. So you can click on the archived claim to see the original claim, and then click back to see the current claim. And this, again, is really helpful if you're on the phone with an insurance payer and they're referencing something about the previous claim or maybe they only have the previous claim on file. You can pull that up and then you can review that together. One thing to note when viewing an archived claim, it will say archived right next to the status badge of the claim, and you are not able to delete an archived claim, but you can download it. So we'll take the original claim reference number, and we'll take it back to our current claim. And as long as this claim has not been submitted, we can make any changes that we need to to it. And we can edit this claim. So we can mark it as a resubmission. We can fill in the code, save, and submit this claim. So that's a full walkthrough of corrected claims. If you find out we actually don't need to submit a corrected claim or for whatever reason, we made this an error, you can always delete this claim before it was submitted, and that would unarchive the original submission. However, once this is submitted, this is out to the insurance. We can't take it back. However, you could continue to create corrected claims. So if a payer, for example, requires you to submit a cancellation first, we could select cancellation, save, and submit this claim. And then right away, we could create a new claim with the we could archive that corrected canceled claim, and we could create another with the resubmission code. And then, again, if you're calling the payer and they're saying we haven't received that cancellation yet, you have a really easy way to flip back and see why I submitted that on August twentieth. We also retain a log of the history of the claim here in the current claim. So you can see, I attempted my first attempt to get this claim paid was on August seventh, so on and so forth, all the way up until you have your latest corrected claim. So that's a little bit about corrected claims. I also want to take a moment to show you what this would look like in your client's profile once a claim is corrected. Let's look at Jamie Appleseed for the appointment on August fourth. You can see we have the original claim here, and then we have two archive claim attempts. You can see the difference by looking at the icons next to the claim reference. So they're saved here in the client's record. One question that I've seen come up is what happens if the appointment needs to change to self pay, and we actually don't need to retain the claim at all. It's still important to have a copy of the claim attempt on file, again, for the history of the appointment and for payment history. However, once the appointment changes to self pay and the balance is moved from insurance to client, it will no longer be recognized as part of your insurance account receivable. It will then be switched to client's accounts receivable. The other question I get is I don't want these archived claims showing up in my reports as denials or hanging out on my record. So we've actually suppressed archived claims from the total claim counts here so that when you view your claims, we they are automatically hidden so that you're not coming here and seeing denials that are no longer relevant because they've been archived and new claims have been created, in an attempt to get paid. Alright. That's everything we wanted to cover today about corrected and edited claims. Thank you so much for your time. It's feedback from practices like yours and clinicians like you that help inform these features that we build. So, again, thank you so much, and hope you have a great day.
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.
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 tobecompleted, submit a corrected claim by following these steps:
Open the claim
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
Click Create Corrected Claim
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
Confirm that you’d like to archive the original claim
Make any necessary edits based on what needs to be corrected
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
Return to the top of the claim and click Save
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:
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.
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.
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.
