Resubmit Claims Rejected by Payer/Insurance Company

Resubmit a claim that has been rejected by the payer/insurance company. This requires the Claim Frequency Type Code or Submission Type be changed from Original to another type, and must include an original reference number or ICN.

Billing->Patient Account->Claims tab/Insurance tab/Demographics tab

Open patient account to make corrections prior to rebuilding and resubmitting claim

After making corrections to rejected claim, click on the Claims tab. If the claim is rejected for charge details, corrections can be made while adding the ICN/Original Reference number

1. Find the rejected claim in the Claims list and click to highlight line item and open in Claim Details section.

2. Click the box next to On Hold to move the claim to the On Hold section in the Claims Manager.

3. Click More Info button to Edit Claim Details.

Add Original Reference Number/ICN In Misc Details tab

4. Number: Enter ICN/Original Reference Number as shown on explanation of benefits or rejection report.

5. Policy ID: Select payer from drop down list. This list is pulled from the insurance policy information in patient Insurance demographics. If the Policy information is not provided, the claim will reject.

6. Click Save.

Place Worked Claim On Hold

7. Place a check mark to put the claim On Hold to rebuild and resubmit.

Change Claim Frequency Type/Submission Code

8. Rebuild claim.

9. Click to display drop down list. Select Replacement for professional claims, Corrected for  institutional claims, Void to submit a voided claim.

These codes are associated with the Claim Frequency type and are indicated in the electronic file:

Original-1

Corrected-6 (Select for corrected Institutional claims)

Replacement-7 (Select for corrected Professional claims)

Void-8

10. Scrub claim to move it to the Ready to Submit section to be resubmitted to payer.